title: Direct observation of physician counseling on dietary habits and exercise: patient, physician, and office correlates.
abstract: BACKGROUND
  This study documented the frequency and correlates of directly observed physicians' counseling on dietary habits and exercise in private medical practices.
  
  
  METHODS
  Trained medical students observed physician, office, and patient characteristics in 4344 patient visits in 38 nonmetropolitan primary care physician offices.
  
  
  RESULTS
  Counseling rates ranged from 0% in some offices to 55% in others. Physicians counseled patients on dietary habits in 25% of visits and exercise in 20% of visits. Physicians counseled new patients 30% more often than established ones (P < 0.05). Dietary counseling was associated with having dietary and exercise brochures in the office (P < 0.05). When counseling occurred, physicians (rather than patients) initiated both dietary and exercise counseling 61% of the time. Counseling for dietary habits was associated with counseling for exercise (P < 0.05); some physicians may be more likely to give preventive counseling. Counseling was not associated with physicians' age, years in practice, or number of patients per week.
  
  
  CONCLUSIONS
  Physician counseled patients in 20-25% of visits, and this was not affected by physician characteristics. Results suggest that physician counseling protocols and other office prompts should be developed and promoted. Strategies targeting both physician and the health care system may improve the consistency of physician preventive counseling practices.
authors.affiliation: Department of Internal Medicine, University of Missouri in Kansas City, Kansas City, MO 64110, USA.
authors.forename: Nadeem A
authors.initials: NA
authors.lastname: Anis
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Lee
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.forename: K Allen
authors.initials: KA
authors.lastname: Greiner
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D003376:Counseling; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007615:Kansas; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'