title: Changes in functional status related to health maintenance visits to family physicians.
abstract: BACKGROUND
  Physicians do not provide preventive care at the level recommended by national organizations. This may be because of physicians' lack of training or low level of confidence or because of patients' fears, beliefs, and lack of health knowledge.
  
  
  METHODS
  We used an observational prospective cohort study in an academic family practice office to investigate changes in patients' functional status associated with receiving recommendations to change behavior from family physicians. Patients 18 years and older presenting for health maintenance visits to family physicians completed a functional status instrument and a brief intake questionnaire by telephone before their visit. After the visit patients were randomized to a debriefing interview or an observation-only group. The interview included the Patient/Doctor Interaction Scale and an assessment of whether patients received a recommendation to change behavior.
  
  
  RESULTS
  One hundred thirty-two patients were randomized to the debriefing group, and of those, 92% completed assessments at 3 months. Patients reporting recommendations to change behavior had lower scores at 1 and 3 months for mental health, social health, and self-esteem and higher anxiety and depression scores than patients not receiving these recommendations.
  
  
  CONCLUSIONS
  There are declines in social and emotional functional status in patients presenting to family practice clinicians for health maintenance visits during which recommendations for behavioral change were made. Such declines may inhibit physicians from making recommendations for behavioral change or patients from accepting them.
authors.affiliation: Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia 19104-4283, USA. mbowman@mail.med.upenn.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Bowman
authors.forename: M
authors.initials: M
authors.lastname: Dignan
authors.forename: S
authors.initials: S
authors.lastname: Crandall
authors.forename: M
authors.initials: M
authors.lastname: Baier
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015444:Exercise / Q000523:psychology; D005194:Family Practice / Q000706:statistics & numerical data*; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010349:Patient Compliance / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D016540:Smoking Cessation / Q000523:psychology; D013315:Stress, Psychological / Q000517:prevention & control