Lifestyle discussions during doctor-older patient interactions: the role of time in the medical encounter.
BACKGROUND
Although physician influence can be especially powerful with older adults, relatively little is known about how primary care physicians (PCPs) interact with their patients regarding lifestyle issues.


OBJECTIVE
To document the length of time that PCPs discuss lifestyle issues with their older patients and to examine patient, physician, and contextual correlates.


METHODS
Descriptive and multivariate analysis of videotapes of physician-patient encounters.


METHODS
Medical encounters from 3 primary care ambulatory settings.


METHODS
There were 116 ongoing medical encounters with patients aged 65 years or older.


METHODS
Total time spent in physical activity (PA) discussions and total time spent discussing PA, nutrition, and smoking during the medical encounter.


RESULTS
Very little time was spent in lifestyle discussions. On average, PA was discussed for less than a minute (58.28 seconds) and nutrition for slightly less than 90 seconds (83.11 seconds). Only about 10% of the average 17-minute, 22-second encounter was spent on physical activity, nutrition, or smoking topics. Physician supportiveness score (beta = 8.92, P <or= .001) and the number of topics discussed (beta = 106.39, P <or= .001) were significantly correlated with the length of all lifestyle discussion. Lifestyle discussions were also more likely to occur during longer visits.


CONCLUSIONS
There is a critical need for additional training of primary care providers on how to discuss lifestyle issues in the most time-efficient but effective manner to achieve positive behavior change associated with improved health outcomes. There is also a need for the institutionalization of policies to encourage more lifestyle discussions.
Ory
Marcia G
MG
School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, USA. mory@srph.tamhsc.edu
Peck
B Mitchell
BM
Browning
Colette
C
Forjuoh
Samuel N
SN
D000368:Aged; D000553:Ambulatory Care / Q000592:standards* / Q000639:trends; D001291:Attitude of Health Personnel; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D011336:Probability; D011787:Quality of Health Care; D013997:Time Factors; D014741:Video Recording