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

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 discussions 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 discussions took an average of 6 minutes. Conclusions. Nearly 60% of the discussions 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.