Primary Care and Health Promotion: A Model for Preventive Medicine

Johns, Martha B.; Hovell, Melbourne F.; Peddecord, K. Michael; Agras, W. Stewart

doi:10.1016/s0749-3797(18)31235-2

Cited by 16 publications

(5 citation statements)

References 60 publications

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“…Barriers to physician involvement in health promotion and implementation of lifestyle change programs in their practices have been reviewed previously (Johns, Hovell, Ganiats, Peddecord, & Agras, 1987;Oldenburg, Graham-Clarke, Shaw, & Walker, in press). Briefly barriers include (a) a lack of basic behavioural science skills and training, (b) incidental reinforcement for curative care rather than preventive care, (c) time constraints (d) lack of financial incentives, (e) mistaken beliefs about efficacy, and (f) unrealistic expectations of success.…”

Section: Barriers To Effective Behavioural Intervention In the Clinicmentioning

confidence: 99%

The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

Graham-Clarke

Oldenburg

1994

Behav. change

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Physical inactivity is a risk factor for a number of chronic diseases, including cardiovascular disease. Interventions designed to reduce the prevalence of physical inactivity have focused primarily on either adoption of physical activity or noncompliance and relapse, and no interventions have been reported which cover adoption, compliance, maintenance, and relapse, particularly within the clinical setting. TheFresh Startprogram, a multiple risk factor intervention program for the reduction of cardiovascular disease risk factors in general practice patients, was developed to cover all aspects of the adoption and maintenance of habitual physical activity, using Prochaska and DiClemente's Transtheoretical model. The evaluation of the program on cardiovascular disease risk factors and behaviours provided the opportunity to evaluate the impact of a staged program on patient physical activity behaviour. The program was evaluated in a randomised controlled trial in Sydney's Western, South-western, and Wentworth regions with 80 volunteer general practitioners and 758 volunteer patients between January 1991 and January 1993. Self-reported physical activity data were used as the basis for estimating energy expenditure due to leisure-time physical activity. The results failed to show any differences between groups over time, as a function of patients' baseline stages of change, and as a function of baseline activity levels. There were some indications, however, that the least active would respond to doctor-based advice to increase their physical activity, and that doctor advice would lead to a progression inintention to changein approximately 20% of patients. Limitations of the study, the program, and physical activity intervention in the clinical setting are discussed.

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Section: Barriers To Effective Behavioural Intervention In the Clinicmentioning

confidence: 99%

The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

Graham-Clarke

Oldenburg

1994

Behav. change

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“…ReIman asserted that social and economic factors of practice play a greater role in determining physician attitudes toward HPIDP than does medical education (71). Johns wrote, "Health financing encourages limiting time and effort of health care personnel to as little as the public will tolerate" (36).…”

Section: Physician Barriers To Implementationmentioning

confidence: 99%

“…Doctors are probably preselected for their interest in curative care and technology (36). During medical school, students are educated by faculties who value HP/DP less than do practitioners (96) have more positive attitudes toward prevention (67), perhaps evidence for a secular change.…”

Section: Physician Barriers To Implementationmentioning

confidence: 99%

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Decision Making For Introducing Clinical Preventive Services

Pels¹

1989

Annual Review of Public Health

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“…These include a lack of time during the office visit (12), a lack of perceived effectiveness as a counselor (13) and a lack of training in behavioral counseling (14). To address these many barriers, Patrick and coworkers developed a program that combines computer software and physician counseling, i.e., the Patient-Centered Assessment and Counseling for Exercise plus Nutrition (PACE ) program (15)(16)(17)(18)(19)(20), which can be used to increase physical activity and modify eating habits.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a Multicomponent Program (Patient-Centered Assessment and Counseling for Exercise plus Nutrition [PACE+ Japan]) for Lifestyle Modification in Patients with Essential Hypertension

et al. 2004

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With conventional lifestyle modification programs, it can be difficult for hypertensive individuals to modify their lifestyles and maintain the changes. We assessed whether a multicomponent program (patient-centered assessment and counseling for exercise plus nutrition [PACE Japan]) based on behavior theory and social cognitive theory would be effective for treating patients with essential hypertension. We examined 57 outpatients aged 62 10 years with essential hypertension irrespective of antihypertensive drug treatment.Participants were randomly divided into two groups: 1) a PACE Japan follow-up group (n 18), who were given an action-plan sheet and systemic health counseling by a physician and counselor every 4 weeks for 24 weeks, and 2) a PACE Japan-only group (n 20), who were given an action-plan sheet but did not receive counseling. An age-and sex-matched control group (n 19) was also selected. The decrease in systolic blood pressure (SBP) ( SBP SBP at 24 weeks minus that at 0 weeks) in the PACE Japan follow-up group was significantly greater than that in the control group. In addition, the percentage of Fat (%Fat) and urinary sodium extraction (U-Na) in the PACE Japan follow-up group were significantly greater than those in the control group. With regard to changes in total energy expenditure, exercise energy expenditure and total energy intake between 0 weeks and 24 weeks, significant improvements were observed for the PACE Japan follow-up group. U-Na was determined to significantly predict SBP as assessed by stepwise selection. In addition, the partial correlation coefficient of SBP with U-Na was 0.361 ( p 0.

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Primary Care and Health Promotion: A Model for Preventive Medicine

Cited by 16 publications

References 60 publications

The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

The Effectiveness of a General-Practice-Based Physical Activity Intervention on Patient Physical Activity Status

Decision Making For Introducing Clinical Preventive Services

Efficacy of a Multicomponent Program (Patient-Centered Assessment and Counseling for Exercise plus Nutrition [PACE+ Japan]) for Lifestyle Modification in Patients with Essential Hypertension

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