title: Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics.
abstract: OBJECTIVE
  This study assesses the effects of competing demands, such as poor health habits or new medical problems, on health-habit counseling during a primary care visit.
  
  
  METHODS
  We surveyed a consecutive sample of 1,259 patients visiting primary care clinicians at an academic VA medical center. Before the visit, patients reported their health status, health habits, and sociodemographics; immediately after the visit, patients reported reasons for the visit and whether they had been counseled about specific health habits. We scored visit acuity ranging from visits for unscheduled walk-in care or new medical problems to scheduled visits for check-ups or old problems. We defined counseling "triggers" as clinical indications for counseling about particular health habits (e.g., smoking). We developed a logistic model predicting primary care provider counseling during a visit.
  
  
  RESULTS
  Over two-thirds of patients (68.9%) received some health habit counseling. Controlling for other independent variables, patients with more triggers were more likely to report being counseled. Counseling rates went up as visit acuity went down; patients with the lowest visit acuity having 67% greater odds of being counseled than patients with the highest visit acuity.
  
  
  CONCLUSIONS
  Physicians set priorities for health-habit counseling during a visit based on patients' health habit problems or triggers; whether the visit is scheduled or walk-in; and whether the patient has new or acute problems. Future research about primary care performance of health habit counseling should account for these patient and visit characteristics, and prevention-oriented health care organizations should ensure access to scheduled "check-up" visits.
authors.affiliation: VA Center for the Study of Healthcare Provider Behavior, Los Angeles, CA, USA. bruce.chernof@healthnet.com
authors.forename: B A
authors.initials: BA
authors.lastname: Chernof
authors.forename: S E
authors.initials: SE
authors.lastname: Sherman
authors.forename: A B
authors.initials: AB
authors.lastname: Lanto
authors.forename: M L
authors.initials: ML
authors.lastname: Lee
authors.forename: E M
authors.initials: EM
authors.lastname: Yano
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
mesh_terms: D000368:Aged; D002140:California; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data*; D006184:Habits; D015438:Health Behavior; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs