• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1993 July; 83(7): 979–982.
PMCID: PMC1694773

Health promotion counseling of chronic-disease patients during primary care visits.

Abstract

OBJECTIVES. This study was designed to provide an empirical description, based on a review of visit audiotapes, of primary care practice with chronic-disease patients. METHODS. We analyzed 439 interactions between adult patients with chronic disease and 49 physicians. We explored the content, frequency, intensity, and dynamics of health promotion discussion during these routine visits. RESULTS. There was evidence of health promotion discussion in more than half (53%) of the audiotapes reviewed. When life-style topics were discussed, the discussion lasted a mean of 4 1/2 minutes, or 20% of the length of the visit. Diet/weight control was the most frequently discussed topic, followed by exercise, stress, smoking, and alcohol. Stress was by far the most time-consuming topic; stress-related discussion took an average of 6 minutes. CONCLUSIONS. Nearly 60% of the discussion that took place were not merely perfunctory but were attempts to counsel or encourage behavior change in the patient. Physicians used a wide range of behavioral counseling strategies, including providing a rationale for the recommended change and specific instructions to facilitate change. Other strategies noted as "effective" in the literature, however, were used infrequently and indicate obvious areas of weakness in physician performance.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wechsler H, Levine S, Idelson RK, Rohman M, Taylor JO. The physician's role in health promotion--a survey of primary-care practitioners. N Engl J Med. 1983 Jan 13;308(2):97–100. [PubMed]
  • Radecki SE, Mendenhall RC. Patient counselling by primary care physicians: results of a nationwide survey. Patient Educ Couns. 1986 Jun;8(2):165–177. [PubMed]
  • Lewis CE, Clancy C, Leake B, Schwartz JS. The counseling practices of internists. Ann Intern Med. 1991 Jan 1;114(1):54–58. [PubMed]
  • Ockene JK, Quirk ME, Goldberg RJ, Kristeller JL, Donnelly G, Kalan KL, Gould B, Greene HL, Harrison-Atlas R, Pease J, et al. A residents' training program for the development of smoking intervention skills. Arch Intern Med. 1988 May;148(5):1039–1045. [PubMed]
  • Hoppe RB, Farquhar LJ, Henry R, Stoffelmayr B. Residents' attitudes towards and skills in counseling: using undetected standardized patients. J Gen Intern Med. 1990 Sep-Oct;5(5):415–420. [PubMed]
  • Freeman SH. Health promotion talk in family practice encounters. Soc Sci Med. 1987;25(8):961–966. [PubMed]
  • Larsson US, Säljö R, Aronsson K. Patient-doctor communication on smoking and drinking: lifestyle in medical consultations. Soc Sci Med. 1987;25(10):1129–1137. [PubMed]
  • Ley P, Bradshaw PW, Eaves D, Walker CM. A method for increasing patients' recall of information presented by doctors. Psychol Med. 1973 May;3(2):217–220. [PubMed]
  • Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA. 1988 May 20;259(19):2883–2889. [PubMed]
  • Anda RF, Remington PL, Sienko DG, Davis RM. Are physicians advising smokers to quit? The patient's perspective. JAMA. 1987 Apr 10;257(14):1916–1919. [PubMed]
  • Wells KB, Lewis CE, Leake B, Schleiter MK, Brook RH. The practices of general and subspecialty internists in counseling about smoking and exercise. Am J Public Health. 1986 Aug;76(8):1009–1013. [PMC free article] [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...