Sinclair Jennifer, Lawson Beverley, Burge Fred
Dalhousie University, Department of Family Medicine, Abbie J. Lane Bldg, 8th Floor, 5909 Veterans Memorial Lane, Halifax, Canada.
Can Fam Physician. 2008 Mar;54(3):404-12.
To examine whether patients' characteristics, familiarity with the clinic, or perspectives on the quality of their care predict whether they receive advice from physicians regarding diet and exercise.
Secondary data analysis of responses to the Primary Care Practice Survey.
Capital District Health Authority in Nova Scotia.
Residents of the Capital District Health Authority 18 years old and older (N = 1562).
Percentage of patients who reported frequently receiving advice from their family physicians regarding diet and exercise.
Almost 38% of respondents reported frequently receiving advice from their physicians on diet. Those more likely to receive advice on diet were male (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.2 to 2.1), were 35 to 54 years old (compared with those aged 18 to 34) (AOR 1.5, 95% CI 1.1 to 2.2), had more chronic illnesses (AOR 1.3, 95% CI 1.2 to 1.6), had good relationships with their health care providers (AOR 2.3, 95% CI 1.8 to 3.1), or reported higher scores on an enablement scale (AOR 2.2, 95% CI 1.6 to 3.1). Respondents who reported their health status as excellent were less likely to receive advice on diet (AOR 0.5, 95% CI 0.3 to 0.9). About 42% of respondents reported frequently receiving advice on exercise. Men (AOR 1.7, 95% CI 1.3 to 2.2), those older than 35 years (AOR 1.7, 95% CI 1.2 to 2.4 for those aged 35 to 54; AOR 1.6, 95% CI 1.1 to 2.3 for those 55 and older), those rating their health as good (AOR 1.6, 95% CI 1.1 to 2.4), those with more chronic illnesses (AOR 1.3, 95% CI 1.1 to 1.5), and those reporting higher scores on communication (AOR 3.2, 95% CI 2.3 to 4.4) and enablement (AOR 1.8, 95% CI 1.3 to 2.4) scales were more likely to receive advice on exercise.
Strategies to increase the number of patients who receive advice on diet and exercise would likely include enhancing communication between patients and their physicians, improving relationships between patients and their physicians, and improving physicians' ability to help their patients feel enabled to act on advice and cope with their illnesses. Physicians should be aware of their counseling practices and consider discussing healthy behaviour with patients with no obvious risk factors. This would be practising true primary prevention.
探讨患者的特征、对诊所的熟悉程度或对其医疗质量的看法是否能预测他们是否会从医生那里获得关于饮食和运动的建议。
对初级保健实践调查的回复进行二次数据分析。
新斯科舍省的首都地区卫生局。
首都地区卫生局18岁及以上的居民（N = 1562）。
报告经常从家庭医生那里获得饮食和运动建议的患者百分比。
近38%的受访者报告经常从医生那里获得饮食方面的建议。更有可能获得饮食建议的人群包括男性（调整优势比[AOR]为1.6，95%置信区间[CI]为1.2至2.1）、35至54岁的人群（与18至34岁的人群相比）（AOR为1.5，95%CI为1.1至2.2）、患有更多慢性疾病的人群（AOR为1.3，95%CI为1.2至1.6）、与医疗服务提供者关系良好的人群（AOR为2.3，95%CI为1.8至3.1），或在赋能量表上得分较高的人群（AOR为2.2，95%CI为1.6至3.1）。报告健康状况极佳的受访者获得饮食建议的可能性较小（AOR为0.5，95%CI为0.3至0.9）。约42%的受访者报告经常获得运动方面的建议。男性（AOR为1.7，95%CI为1.3至2.2）、35岁以上的人群（35至54岁人群的AOR为1.7，95%CI为1.2至2.4；55岁及以上人群的AOR为1.6，95%CI为1.1至2.3）、将健康状况评为良好的人群（AOR为1.6，95%CI为1.1至2.4）、患有更多慢性疾病的人群（AOR为1.3，95%CI为1.1至1.5），以及在沟通（AOR为3.2，95%CI为2.3至4.4）和赋能（AOR为1.8，95%CI为1.3至2.4）量表上得分较高的人群更有可能获得运动方面的建议。
增加获得饮食和运动建议患者数量的策略可能包括加强患者与医生之间的沟通、改善患者与医生之间的关系，以及提高医生帮助患者有能力按照建议行动并应对疾病的能力。医生应该了解他们的咨询实践，并考虑与没有明显危险因素的患者讨论健康行为。这将是真正的一级预防实践。
