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Personal Health Practices and Patient Counseling of German Physicians in Private Practice  [PDF]
Edgar Voltmer,Erica Frank,Claudia Spahn
ISRN Epidemiology , 2013, DOI: 10.5402/2013/176020
Abstract: We examined physicians' personal health behaviors and the influence on their patient counseling practices in a representative sample ( ) of physicians in private practice in Schleswig-Holstein, Germany. Physicians reported significantly better physical but poorer mental health compared to the general population (GP; ). The majority presented with normal weight (47.9% male, 73.1% female physicians versus 24.5/41.0% GP) or overweight (47.5% male, 20.0% female versus 52.9/35.6% GP). Frequency of exercise and fruit and vegetable consumption was higher than in the GP. About 70% drank coffee or tea more than once a day, but only 13.2% of female and 21.8% of male physicians were current smokers (GP 20.1/30.5%). More than half (56.1%) usually or always counseled a typical patient on exercise versus nutrition (47.0%), weight (45.8%), smoking (39.9%), and alcohol (30.0%). Doctors with better personal exercise, nutrition, smoking, and alcohol behaviors counseled their patients significantly more often on related topics. Despite better physical health and health behaviors in these German doctors compared to the GP, there is room for improvement (smoking, overweight), which could be expected to positively influence the counseling practice and impact of doctors' role modeling on patients. 1. Introduction Chronic, lifestyle-related diseases challenge health care systems worldwide with cardiovascular disease, chronic pulmonary disease, diabetes, and cancer accounting for about two-thirds of global mortality [1]. Lifestyle choices are critical for the prevention of these diseases [2]: WHO reports that the four leading risk factors for noncommunicable diseases are tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. Globally, tobacco causes almost six million deaths annually and alcohol 2.3 million. Insufficient exercise increases all-cause mortality 20 to 30%, and fruit and vegetable consumption is important to prevent obesity, cardiovascular disease, and gastrointestinal cancers [1]. For most patients in western societies, physicians in private practice are their first contact regarding their personal health practices. Studies have shown the importance of doctors’ recommendations for their patients’ practices [3]. It has also been shown in North American studies that physicians have healthier habits than the general population and that doctors with the healthiest habits are more likely to counsel their patients about healthy lifestyle practices [4, 5]. In addition, physicians with healthier behaviors, who discuss it with their
Smoking habits of physicians in Enugu, Nigeria
TA Okeke
Journal of Community Medicine and Primary Health Care , 2004,
Abstract: Background: Physicians are highly respected in their communities. They play a crucial role in issues related to health and people turn to them for advice and consultation. This study was therefore conducted to determine the prevalence of smoking among physicians in Enugu, Nigeria, a group of health professionals who should act as role models. Methods: A cross-sectional descriptive survey was carried out between June and July 2004 at a tertiary health facility located in Enugu, the capital of Enugu state in south-east Nigeria. Information was obtained with the aid of a self-administered structured questionnaire. Results: Of the 450 physicians contacted, 377 completed the questionnaire, giving a response rate of 83.8%. The mean age of the respondents was 30.9 years and majority 319(84.6%) were males. The physicians comprised of about 8 % current smokers, 13.3% ex-smokers and 78.8% who had never smoked. Majority (60%) of smokers began smoking before the age of 20 and reasons for starting included curiosity (55%), peer pressure (35%), stress of medical school (22.5%) and having a family member who smoked (10%). All respondents agreed that smoking is hazardous to health and majority recognized the association between smoking and various diseases. Non -smokers were more likely than smokers to counsel their patients on the dangers of smoking and to consider themselves as role models. This difference was found to be statistically significant (p<0.05). Majority (60.5%) would recommend a ban on smoking in public places, 50.7% an increase in price of cigarettes and 31.3% prohibition of advertisement of cigarettes. Conclusion: Because of their important role as health educators, physicians should not smoke. It is highly recommended that smoking cessation training be implemented in medical schools and also be made available to practicing Nigerian physicians through continuing medical education. A national policy on tobacco control should also be developed and strictly enforced. KEY WORDS: Tobacco smoking; Physicians; Enugu Journal of Community Medicine & Primary Health Care Vol.16(2) 2004: 34-38
Determinants of primary care physicians’ practice of prostate cancer counseling and screening  [PDF]
Danny M. Rabah, Mostafa A. Arafa
Health (Health) , 2010, DOI: 10.4236/health.2010.211195
Abstract: Objective: The objective was to examine practices of primary care physicians and its determinants towards prostate cancer screening. Methods: Data was obtained from 204 primary care physicians using self-reports of prostate cancer screening practices, knowledge, attitudes towards prostate cancer screening. Results: nearly half of the respondent (54.7%) were practicing counseling and referring prostate cancer patients. The mean correct knowledge score was 54.3%, their attitude was not strong; the only statement that nearly seventy percent of physicians agreed upon was about the value of screening, however, the reliability and evidence to support DRE & PSA were in question. Knowledge and attitude were found to be the most significant predictors that determine physicians’ self practice. Conclusion: Background information and attitudes are important determinants of physicians’ practice behavior towards prostate cancer counseling and referral in our study.
Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?
Melanie Jay, Colleen Gillespie, Sheira Schlair, Scott Sherman, Adina Kalet
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-159
Abstract: We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation.137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6) of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55), intending to eat better (OR 1.23, CI 1.06-1.44), and intending to exercise regularly (OR 1.14, CI 1.00-1.31). Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47) and exercise (OR 26.07, CI 3.70-83.93).Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales) was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity counseling leads to improved behavioral and weight outcomes.There is consensus that physicians should counsel obese patients to lose weight [1-4]. Physician weight loss counseling is generally positively associated with self-reported behavior change in patients [5-7], but the quality of physician counseling is rarely assessed [8]. Physicians often fail to counsel obese patients [5,9-12] and, when counseling occurs, it is often of po
Association of depressive symptoms with dietary habits among Japanese physicians  [PDF]
Koji Wada, Yukiko Suehiro, Hiroshi Ohta, Toru Yoshikawa, Takashi Hosaka
Open Journal of Preventive Medicine (OJPM) , 2012, DOI: 10.4236/ojpm.2012.23041
Abstract: The aim of this study was to determine the association of depressive symptoms with dietary habits among physicians working in hospitals in Japan. We mailed an anonymous questionnaire with the Quick Inventory of Depressive Symptomatology and items about dietary habits to 10,000 randomly selected physicians. Logistic regression analysis was used to explore the association of depressive symptoms with dietary habits. The participants comprised 3862 physicians (3025 men and 837 women). Among the respondents, 252 (8.3%) men and 88 (10.5%) women were determined to be in depressive symptoms. For men, “never eat a balanced diet” (Odds ratio; 95% confidence interval, 2.54; 1.70 - 3.80), and for women “eat quite small meals” (3.81; 1.14 - 13.1), “always eat until full” (4.40; 1.48 - 13.1), and “never eat a balanced diet” (3.05; 1.49 - 6.23) were associated with depressive symptoms. For men, “do not eat too much” (0.57; 0.39 - 0.83) was associated with prevention of depression. Physicians should recognize the important role of healthy dietary habits in good mental health. Hospitals should intervene to help physicians address depressive symptoms and dietary habits.
Smoking Status and Cessation Counseling Practices Among Physicians, Guangxi, China, 2007  [cached]
Jiatong Zhou, MD,Abu S. Abdullah, MD, PhD,Vivian C. Pun, MPH,Dongmei Huang, MD
Preventing Chronic Disease , 2010,
Abstract: IntroductionWe examined Chinese physicians’ smoking behavior, knowledge of smoking’s health effects, and compliance with accepted cessation counseling practices.MethodsWe used a structured questionnaire adapted from the Global Health Professionals Survey of the World Health Organization to survey Chinese physicians based at 5 hospitals in Nanning, Guangxi Province, China.ResultsThe response rate was 85% for a total of 673 completed questionnaires. Of the 673 respondents, 73% were men, 42% were aged 30 years or younger, and 26% were smokers (men, 35%; women, 3%). Only 28% of the smokers were ready to quit immediately. A substantial proportion of physicians did not have adequate knowledge of smoking-related health hazards or favorable attitudes toward smoking cessation counseling. Asking patients whether they smoked and recording smoking status in the medical record were significantly associated with being female and being very well or somewhat prepared to counsel patients about smoking cessation. Advising patients to quit smoking was significantly associated with being female, being a nonsmoker, being very well or somewhat prepared to counsel patients about smoking cessation, and having read any smoking cessation guidelines.ConclusionsOur findings suggest that smoking is common among male Chinese physicians and that Chinese physicians have inadequate knowledge of smoking’s health hazards and of how to help smokers quit. Physicians in China and their patients who smoke would benefit from widely accessible Chinese clinical practice guidelines on smoking cessation, better medical school education about the health risks of smoking, and government funding of cessation medications.
Converting habits of antibiotic prescribing for respiratory tract infections in German primary care – the cluster-randomized controlled CHANGE-2 trial  [cached]
Altiner Attila,Berner Reinhard,Diener Annette,Feldmeier Gregor
BMC Family Practice , 2012, DOI: 10.1186/1471-2296-13-124
Abstract: Background With an average prescription rate of 50%, in German primary care antibiotics are still too frequently prescribed for respiratory tract infections. The over-prescription of antibiotics is often explained by perceived patient pressure and fears of a complicated disease progression. The CHANGE-2 trial will test the effectiveness of two interventions to reduce the rate of inappropriate antibiotic prescriptions for adults and children suffering from respiratory tract infections in German primary care. Methods/Design The study is a three-arm cluster-randomized controlled trial that measures antibiotic prescription rates over three successive winter periods and reverts to administrative data of the German statutory health insurance company AOK. More than 30,000 patients in two regions of Germany, who visit their general practitioner or pediatrician for respiratory tract infections will be included. Interventions are: A) communication training for general practitioners and pediatricians and B) intervention A plus point-of-care testing. Both interventions are tested against usual care. Outcome measure is the physicians’ antibiotic prescription rate for respiratory tract infections derived from data of the health insurance company AOK. Secondary outcomes include reconsultation rate, complications, and hospital admissions. Discussion Major aim of the study is to improve the process of decision-making and to ensure that patients who are likely to benefit from antibiotics are treated accordingly. Our approach is simple to implement and might be used rapidly among general practitioners and pediatricians. We expect the results of this trial to have major impact on antibiotic prescription strategies and practices in Germany, both among general practitioners and pediatricians. Trial registration The study is registered at the Current Controlled Trials Ltd (ISRCTN01559032)
Impact of an extensive asthma education campaign for physicians on their drug prescription practices  [cached]
Al-Shimemeri Abdullah,Al-Ghadeer Hend,Giridhar Hema,Al-Jahdali Hamdan
Annals of Thoracic Medicine , 2006,
Abstract: OBJECTIVE: To evaluate the impact of an extensive education campaign for physicians, in effecting positive changes, in their asthma prescription practice, in line with the ′Saudi protocol for diagnosis and management of asthma′. MATERIALS AND METHODS : An extensive campaign on asthma management for physicians in Saudi Arabia was conducted in 1995-1996, based on the ′Saudi protocol for asthma diagnosis and management′. During this campaign, one day courses-cum-workshops were held in 19 different cities, for over 2500 physicians (8% of all physicians in the kingdom). To evaluate the changes in asthma prescription, we retrospectively reviewed the charts of 98 asthmatic patients in 1994 and 100 patients in 1997, attending the outpatient department of two tertiary care hospitals, with over 500 beds, each in Riyadh and Jeddah. Data on demographic profile of the patients, Pulmonary function test and medications prescribed, were analysed and compared between the two groups. RESULTS: The mean age and severity of asthma was similar in both the groups.The prescription rate of inhaled steroids and inhaled beta-agonists increased significantly, with decrease in the use of oral beta-agonists, oral steroids, Theophylline, sodium cromoglycate and ketotifen. Conclusion: The use of inhaled steroids and inhaled beta agonists, considerably improved after the asthma education campaign for physicians in Saudi Arabia. Education campaign for physicians may be effective and could help in the improvement of clinical practice towards a specific disease.
Predictors of physicians’ practices related to nutritional counseling and management in Riyadh City
MN Al-Muammar
Alexandria Journal of Medicine , 2012,
Abstract: Background: A growing interest has become increasing in the role of physicians as effective resources for the promotion of good nutritional practices, however, the factors that impede their nutritional counseling and management practice (NC&M) are not clearly understood in Saudi Arabia. Objectives: The objectives of the study were to investigate physicians’ practices concerning NC&M and to explore some determinants that predict such practices. Results: Data of 266 physicians working in big hospitals in Riyadh showed that only 7.9% of the respondents reported that they were practicing all aspects of NC&M; including nutritional assessment, therapy, and education. Those who practiced any one of these aspects ranged between 13.9– 40.2%, meanwhile, 28% frankly reported that they did not practice NC&M. In the last year, the mean percentage of patients placed on nutrition therapy was 24.15 ± 27.78% and the mean percentage of clinic time dedicated to NC&M was 21.49 ±20.54%. Most of the respondents (72.9%) had poor nutritional knowledge score. Overall, 19.2% previously attended CME in nutrition. Only 1.5% and 28.6% self-assessed themselves as ‘‘outstanding’’ and ‘‘good’’ in NC&M skills and the mean total self-efficacy in NC&M was moderate. The majority (77.8%) perceived NC&M as highly or moderately relevant to their specialties. Physicians attitude and perceived efficacy towards NC&M was moderately high as the mean scores were greater than their midpoint. Their perceived barriers of NC&M were considerably moderate; as the mean total score was found to be near the midpoint of that scale. Among the seven independent variables entered the binary logistic regression of physicians practice of NC&M, only the knowledge, attitude, and self-efficacy scores were significantly associated with their NC&M practice. These three predictors contributed by 23.5% of the variation of physician practice of NC&M. Conclusions: Physicians knowledge, self-efficacy, attitudes and other factors should be stressed in any intervention warranted to improve their nutritional practices.
Dietary Advice on Prescription: A novel approach to dietary counseling  [cached]
Gunnar Johansson
International Journal of Qualitative Studies on Health & Well-Being , 2011, DOI: 10.3402/qhw.v6i2.7136
Abstract: This article describes a novel approach to giving dietary advice, which is called “Dietary Advice on Prescription” (DAP; Matordning p Recept [MoR] in Swedish). It is the same principle as prescription on medicine and “Physical Activity on Prescription” (PAP; Fysisk aktivitet p Recept [FaR] in Swedish). The main idea is that a written prescription will strengthen the oral advice and emphasize certain aspects of the dietary recommendation. The DAP is on the brink of being tested in a planned study.
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