Heywood A, Firman D, Sanson-Fisher R, Mudge P, Ring I
Epidemiology and Health Information Branch, Queensland Health, Brisbane, Australia.
Prev Med. 1996 May-Jun;25(3):268-76. doi: 10.1006/pmed.1996.0056.
Patient, physician, and consultation variables associated with overweight and smoking counseling in general practice consultations were examined.
A random sample of full-time general practitioners was used. The sample consisted of 7,160 patients from 230 GPs who attended for consultations on consecutive days, and self-reported information from the doctor and the patient was collected via questionnaire. The aim of this paper is to identify variables associated with the doctor's identification of overweight and smoking status and with the occurrence of counseling for these two behavioral risk factors.
Forty percent of patients were overweight (BMI > 24) and 25% were self-reported smokers. Doctors identified 59% of overweight patients and 66% of smokers. Doctors only counseled patients identified as having the risk factor, counseling 36% of identified overweight patients and 49% of identified smokers. Identification of overweight was associated with being female, being heavier, having been previously counseled, being less well educated, presenting with an associated condition, and visiting a doctor who is younger and knows the patient's medical history well. Counseling for overweight was associated with being younger, being previously counseled, presenting with an associated condition, presenting for a routine checkup, visiting a GP who generally has longer consultations, having BP measured in the consultation, visiting an older doctor and visiting a doctor who considers identification of risk behaviors important. Identification of smokers was associated with being a heavier smoker, with those who had been previously counseled, with marital status other than single or married, with a BP measurement being taken in the consultation, and with a doctor who believed it possible to influence lifestyle change. Counseling for smoking was associated with younger patients, longer consultations, previous counseling, BP measurement, presenting with an associated condition, and not presenting frequently.
We have identified factors associated with counseling about behavioral risk factors which provide a framework for planning education programs to increase the level of primary preventive activities within general practice.
研究了在全科医疗会诊中与超重及吸烟咨询相关的患者、医生和会诊变量。
采用全职全科医生的随机样本。样本包括来自230名全科医生的7160名连续数日前来会诊的患者，并通过问卷调查收集医生和患者的自我报告信息。本文旨在确定与医生对超重和吸烟状况的识别以及针对这两种行为风险因素的咨询发生情况相关的变量。
40%的患者超重（体重指数>24），25%的患者自我报告为吸烟者。医生识别出59%的超重患者和66%的吸烟者。医生仅对被识别为有风险因素的患者进行咨询，对36%被识别出的超重患者和49%被识别出的吸烟者进行了咨询。超重的识别与女性、体重较重、曾接受过咨询、教育程度较低、伴有相关疾病以及就诊于较年轻且熟悉患者病史的医生有关。超重咨询与较年轻、曾接受过咨询、伴有相关疾病、进行常规体检、就诊于会诊时间通常较长的全科医生、会诊时测量血压、就诊于年长医生以及就诊于认为识别风险行为很重要的医生有关。吸烟者的识别与吸烟量较大、曾接受过咨询、婚姻状况非单身或已婚、会诊时测量血压以及认为有可能影响生活方式改变的医生有关。吸烟咨询与年轻患者、会诊时间较长、既往咨询、测量血压、伴有相关疾病以及不频繁就诊有关。
我们已经确定了与行为风险因素咨询相关的因素，这些因素为规划教育项目提供了一个框架，以提高全科医疗中初级预防活动的水平。
