Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA.
J Am Board Fam Med. 2011 Jan-Feb;24(1):26-32. doi: 10.3122/jabfm.2011.01.100137.
discussing self-care activities like exercise is challenging with the many competing demands during primary care encounters. Our objective was to study the relationship between the Chronic Care Model (CCM) score in the clinic and time spent by the physicians discussing exercise during encounters with diabetic patients.
consecutive patients with diabetes across 20 primary care clinics in South Texas were included. Time spent discussing exercise was determined using the Davis Observation Code on audio recordings of the visits. Clinicians completed the Assessment of Chronic Illness Care survey, a validated measure of the extent to which care delivered is consistent with the CCM. Data were analyzed using hierarchical linear models.
a total of 162 transcribed recordings were analyzed. Age, the number of problems addressed, stage of change (SOC), and overall length of the visit were associated with time spent discussing exercise. There was a significant relationship between clinic CCM score and time spent by physicians advising about exercise, independent of SOC for exercise (P < .01). Also, a discussion about exercise was more likely to occur with patients who were in the contemplation SOC for exercise.
discussions of exercise may be 18 to 33 seconds longer in clinics with full implementation of the CCM compared with those with basic implementation. Facilitating more complete CCM implementation in clinics with a basic level of CCM that serve a population of patients who are sedentary may realize the most benefit.
在初级保健就诊期间，由于存在许多相互竞争的需求，讨论自我保健活动（如运动）具有挑战性。我们的目的是研究诊所中的慢性关怀模型（CCM）评分与医生在与糖尿病患者就诊时讨论运动所花费的时间之间的关系。
纳入了德克萨斯州南部 20 家初级保健诊所的连续糖尿病患者。使用戴维斯观察代码（Davis Observation Code）在就诊的音频记录中确定讨论运动所花费的时间。临床医生完成了慢性病护理评估调查（Assessment of Chronic Illness Care survey），这是衡量护理是否符合 CCM 的有效措施。使用分层线性模型对数据进行分析。
总共分析了 162 份转录记录。年龄、所解决问题的数量、改变阶段（SOC）和就诊的总时长与讨论运动所花费的时间相关。诊所 CCM 评分与医生提供关于运动的建议所花费的时间之间存在显著关系，而与运动的 SOC 无关（P<.01）。此外，对于处于运动 SOC 考虑阶段的患者，更有可能进行关于运动的讨论。
与基本实施 CCM 的诊所相比，全面实施 CCM 的诊所中关于运动的讨论可能会延长 18 到 33 秒。在服务于久坐不动的患者人群的基础 CCM 水平的诊所中，促进更完整的 CCM 实施可能会获得最大的收益。
