title: The Chronic Care Model and Exercise Discussions during Primary Care Diabetes Encounters.
abstract: BACKGROUND
  discussing self-care activities like exercise is challenging with the many competing demands during primary care encounters. Our objective was to study the relationship between the Chronic Care Model (CCM) score in the clinic and time spent by the physicians discussing exercise during encounters with diabetic patients.
  
  
  METHODS
  consecutive patients with diabetes across 20 primary care clinics in South Texas were included. Time spent discussing exercise was determined using the Davis Observation Code on audio recordings of the visits. Clinicians completed the Assessment of Chronic Illness Care survey, a validated measure of the extent to which care delivered is consistent with the CCM. Data were analyzed using hierarchical linear models.
  
  
  RESULTS
  a total of 162 transcribed recordings were analyzed. Age, the number of problems addressed, stage of change (SOC), and overall length of the visit were associated with time spent discussing exercise. There was a significant relationship between clinic CCM score and time spent by physicians advising about exercise, independent of SOC for exercise (P < .01). Also, a discussion about exercise was more likely to occur with patients who were in the contemplation SOC for exercise.
  
  
  CONCLUSIONS
  discussions of exercise may be 18 to 33 seconds longer in clinics with full implementation of the CCM compared with those with basic implementation. Facilitating more complete CCM implementation in clinics with a basic level of CCM that serve a population of patients who are sedentary may realize the most benefit.
authors.affiliation: Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA. Pateln4@uthscsa.edu
authors.forename: Neela K
authors.initials: NK
authors.lastname: Patel
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods / Q000706:statistics & numerical data*; D019468:Disease Management; D015444:Exercise / Q000502:physiology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013637:Tape Recording; D013781:Texas; D013997:Time Factors