The decision to offer patients preventive counseling is complex, say researchers in an article in the July/August issue of Annals of Family Medicine. "The Art and Complexity of Primary Care Clinicians' Preventive Counseling Decisions: Obesity as a Case Study" builds on clinicians' reports about their decisions to counsel obese patients.
Clinicians Weigh In on Obesity Counseling
'Decision Is Complex,' Study Says
By News Staff
The presence or absence of supportive community resources, such as exercise classes for the overweight, affect clinicians' decisions about whether to offer counseling on obesity, suggests a study in Annals of Family Medicine.
"Clinicians noted the high prevalence of obese patients and the lack of success in helping patients achieve sustained weight loss," say the authors, illustrating the scope of the counseling challenge.
The clinicians in the study, more than half of them FPs, belonged to RIOS Net, a practice-based research network in the Southwest; RIOS stands for Research Involving Outpatient Settings. The researchers were led by Andrew Sussman, Ph.D., of the family and community medicine department at the University of New Mexico, Albuquerque. They conducted interviews or focus groups with 30 RIOS Net members and analyzed surveys from 146 network members. The clinicians in the study practiced in community health centers; Indian Health Service clinics; and University of New Mexico primary care sites that served low-income, predominantly Hispanic and Native American communities in New Mexico.
Focusing on visits with obese patients, researchers asked clinicians what factors influenced their decision to offer preventive counseling. Researchers then grouped clinicians' answers into two sets of factors. Relatively stable factors, such as a clinician's life values and definitions of success and the availability of supportive community resources, "set the stage" for patient visits. "Most clinicians reported a counseling goal aimed at improving general health habits and wellness rather than at achieving a recommended weight," says the article. "As one clinician remarked, 'Success is anything that has a favorable impact on (patients') health.'"
More dynamic factors that exert influence "as the door opens" into the exam room include the patient's agenda and receptivity to proposed counseling. Clinicians catch patients' verbal and nonverbal cues. The article quotes one clinician as saying a patient's closed body language and verbal responses might convey the sense that "You know, I've heard this before, doc. Don't keep pushing this."
Ninety-four percent of survey respondents reported searching for a teachable moment. The article notes that one clinician said, "Often you can segue into it (obesity counseling) if the patient has diabetes, if they have heart disease, if they have arthritis and they're looking at a knee replacement or some other arthritic problem that's being aggravated by the fact that they're overweight."
How can this Annals article apply to family physicians' everyday practice? "Our results suggest that increasing clinicians' sense of efficacy in enhancing patient motivation for change may increase counseling. Effective models using readiness-to-change and motivational interviewing techniques may provide this," say the researchers. "Reorienting practice structures to support the delivery of counseling in all visits may also facilitate increased counseling."
The clinicians in the study, more than half of them FPs, belonged to RIOS Net, a practice-based research network in the Southwest; RIOS stands for Research Involving Outpatient Settings. The researchers were led by Andrew Sussman, Ph.D., of the family and community medicine department at the University of New Mexico, Albuquerque. They conducted interviews or focus groups with 30 RIOS Net members and analyzed surveys from 146 network members. The clinicians in the study practiced in community health centers; Indian Health Service clinics; and University of New Mexico primary care sites that served low-income, predominantly Hispanic and Native American communities in New Mexico.
Focusing on visits with obese patients, researchers asked clinicians what factors influenced their decision to offer preventive counseling. Researchers then grouped clinicians' answers into two sets of factors. Relatively stable factors, such as a clinician's life values and definitions of success and the availability of supportive community resources, "set the stage" for patient visits. "Most clinicians reported a counseling goal aimed at improving general health habits and wellness rather than at achieving a recommended weight," says the article. "As one clinician remarked, 'Success is anything that has a favorable impact on (patients') health.'"
More dynamic factors that exert influence "as the door opens" into the exam room include the patient's agenda and receptivity to proposed counseling. Clinicians catch patients' verbal and nonverbal cues. The article quotes one clinician as saying a patient's closed body language and verbal responses might convey the sense that "You know, I've heard this before, doc. Don't keep pushing this."
Ninety-four percent of survey respondents reported searching for a teachable moment. The article notes that one clinician said, "Often you can segue into it (obesity counseling) if the patient has diabetes, if they have heart disease, if they have arthritis and they're looking at a knee replacement or some other arthritic problem that's being aggravated by the fact that they're overweight."
How can this Annals article apply to family physicians' everyday practice? "Our results suggest that increasing clinicians' sense of efficacy in enhancing patient motivation for change may increase counseling. Effective models using readiness-to-change and motivational interviewing techniques may provide this," say the researchers. "Reorienting practice structures to support the delivery of counseling in all visits may also facilitate increased counseling."
