Makoul Gregory, Dhurandhar Anjali, Goel Mita Sanghavi, Scholtens Denise, Rubin Alan S
Program in Communication and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Gen Intern Med. 2006 Jul;21(7):698-703. doi: 10.1111/j.1525-1497.2006.00467.x.
As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate.
To assess the scope of health risk screening and characterize the communication content of counseling for health behavior change in 2 general internal medicine practices.
We studied videotapes of 125 new patient visits to General Internists affiliated with academic medical centers in Chicago, IL (70%) and Burlington, VT (30%). All videotapes were content analyzed to examine (1) the incidence and outcome of screening for diet, exercise, tobacco, alcohol, drugs, sex, seatbelt use, helmet use, firearms, smoke detectors, and sun exposure; (2) the content of counseling for at-risk behaviors, with a focus on 11 counseling tasks associated with health behavior change.
Patient age in these 125 initial visits ranged from 22 to 85 years. Within the 91 visits that included at least 1 screening attempt, there were a total of 361 distinct screening discussions (mean=3.9, SD=2.2, range=1 to 9). Seventy-four (20.5%) of the 361 screening discussions revealed an at-risk behavior. On average, 2.4 of the 11 counseling tasks were accomplished for each of the 74 behavioral health risks (SD=2.2, range 0 to 9); only education about the problem (56.8%) and general advice about the solution (62.2%) were evident in more than half of the counseling attempts.
This observational study reveals that communication tasks associated with successful counseling were relatively infrequent occurrences during initial visits in 2 primary care practices.
由于行为健康风险是美国可预防发病和死亡的主要原因，国家指南建议医生定期为患者筛查风险因素，并酌情提供咨询。
评估健康风险筛查的范围，并描述两家普通内科诊所中针对健康行为改变的咨询沟通内容。
我们研究了125例新患者就诊的录像带，这些患者来自伊利诺伊州芝加哥（70%）和佛蒙特州伯灵顿（30%）的学术医疗中心的普通内科医生。对所有录像带进行内容分析，以检查：（1）饮食、运动、烟草、酒精、药物、性、安全带使用、头盔使用、枪支、烟雾探测器和日晒筛查的发生率及结果；（2）针对高危行为的咨询内容，重点关注与健康行为改变相关的11项咨询任务。
这125例初次就诊患者的年龄在22岁至85岁之间。在91例至少进行了1次筛查尝试的就诊中，共有361次不同的筛查讨论（平均值=3.9，标准差=2.2，范围=1至9）。361次筛查讨论中有74次（20.5%）发现了高危行为。对于74项行为健康风险中的每一项，平均完成了11项咨询任务中的2.4项（标准差=2.2，范围0至9）；在超过一半的咨询尝试中，仅出现了关于问题的教育（56.8%）和关于解决方案的一般建议（62.2%）。
这项观察性研究表明在两家初级保健诊所的初次就诊期间，与成功咨询相关的沟通任务相对较少出现。
