New York University School of Medicine, Division of General Internal Medicine, New York, NY, USA.
BMC Health Serv Res. 2010 Jun 9;10:159. doi: 10.1186/1472-6963-10-159.
Physicians are encouraged to counsel obese patients to lose weight, but studies measuring the quality of physicians' counseling are rare. We sought to describe the quality of physicians' obesity counseling and to determine associations between the quality of counseling and obese patients' motivation and intentions to lose weight, key predictors of behavior change.
We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation.
137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6) of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55), intending to eat better (OR 1.23, CI 1.06-1.44), and intending to exercise regularly (OR 1.14, CI 1.00-1.31). Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47) and exercise (OR 26.07, CI 3.70-83.93).
Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales) was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity counseling leads to improved behavioral and weight outcomes.
鼓励医生对肥胖患者进行减肥咨询，但评估医生咨询质量的研究很少。我们旨在描述医生肥胖咨询的质量，并确定咨询质量与肥胖患者减肥的动机和意图之间的关系，这些是行为改变的关键预测因素。
我们对肥胖患者进行了就诊后调查，以评估医生使用 5A 咨询技巧的情况以及医生的整体以患者为中心程度。患者还报告了他们减肥的动机和改善饮食及锻炼的意愿。采用单因素方差分析来描述按自我报告的意图和动机水平分层的咨询实践次数的平均值差异。进行逻辑回归分析以评估使用的 5A 咨询实践次数与患者意图和动机之间的关联。
共纳入了 23 名医生的 137 名患者进行分析。尽管 85%的患者接受了肥胖咨询，但医生平均仅使用了 18 种可能的 5A 咨询实践中的 5.3（SD=4.6）项。动机和意图水平较高的患者比动机和意图水平较低的患者接受的 5A 咨询技术更多。每增加一项咨询实践与减肥的动机增加相关（OR 1.31，CI 1.11-1.55）、改善饮食的意图增加相关（OR 1.23，CI 1.06-1.44）和定期锻炼的意图增加相关（OR 1.14，CI 1.00-1.31）。医生的以患者为中心程度也与改善饮食的意图（OR 2.96，CI 1.03-8.47）和锻炼的意图（OR 26.07，CI 3.70-83.93）呈正相关。
（使用 5A 咨询框架和以患者为中心的量表测量的）医生咨询质量与减肥的动机和改变行为的意图相关。未来的研究应确定更高质量的肥胖咨询是否会导致行为和体重结果的改善。
