Sherman Michelle D, Hooker Stephanie A
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
Fam Pract. 2020 Sep 5;37(4):493-498. doi: 10.1093/fampra/cmaa001.
Approximately 40% of deaths in the USA are attributable to modifiable health behaviours. Despite clear recommendations and practice guidelines, primary care physicians (PCPs) generally do not dedicate much time to addressing health behaviours, thereby missing opportunities to improve patient well-being.
OBJECTIVE(S): To examine what health behaviour change techniques PCPs use with their patients, including frequency of use, confidence in and perceived effectiveness of those interventions.
Using a cross-sectional study design, family medicine resident and faculty physicians (n = 68) from three residency training programs completed an anonymous online survey. Questions explored their use of, confidence in and perceived effectiveness of health behaviour change interventions for six domains: physical activity, healthy eating, medication adherence, smoking cessation, sleep and alcohol reduction. Qualitative responses to open-ended questions were double coded by two independent raters. PCPs' open-ended responses to questions regarding specific intervention techniques were coded using an evidence-based behaviour change taxonomy.
Although PCPs indicated that they address health behaviour topics quite frequently with their patients, they reported only moderate confidence and low-to-moderate perceived effectiveness with their interventions. The most frequently cited technique was providing instruction (telling patients what to do). PCPs reported lowest frequency of addressing, lowest confidence and lowest effectiveness regarding helping patients decrease their use of alcohol. Insufficient time and perceived low patient motivation were commonly cited barriers.
These findings highlight the need for the development and evaluation of educational curricula to teach physicians brief, evidence-based approaches to helping patients make these changes in their health-related behaviours.
在美国，约40%的死亡可归因于可改变的健康行为。尽管有明确的建议和实践指南，但初级保健医生（PCP）通常不会花费太多时间来解决健康行为问题，从而错失改善患者福祉的机会。
研究初级保健医生对患者使用哪些健康行为改变技巧，包括使用频率、对这些干预措施的确信程度以及感知到的效果。
采用横断面研究设计，来自三个住院医师培训项目的家庭医学住院医师和教员医生（n = 68）完成了一项匿名在线调查。问题探讨了他们在身体活动、健康饮食、药物依从性、戒烟、睡眠和减少饮酒六个领域中对健康行为改变干预措施的使用情况、确信程度和感知效果。对开放式问题的定性回答由两名独立评分者进行双重编码。初级保健医生对有关特定干预技巧问题的开放式回答使用基于证据的行为改变分类法进行编码。
尽管初级保健医生表示他们经常与患者讨论健康行为话题，但他们报告称对自己的干预措施只有中等的确信程度，且感知效果为低到中等。最常被提及的技巧是提供指导（告诉患者该怎么做）。初级保健医生报告称，在帮助患者减少饮酒方面，讨论频率最低、确信程度最低且效果最差。时间不足和患者动机被认为较低是常见的障碍。
这些发现凸显了开发和评估教育课程的必要性，以教导医生采用简短、基于证据的方法来帮助患者改变与健康相关的行为。
