The Art and Complexity of Primary Care Clinicians’ Preventive Counseling Decisions: Obesity as a Case Study

Andrew L. Sussman; Robert L. Williams; Robert Leverence; Park W. Gloyd; Benjamin F. Crabtree

doi:10.1370/afm.566

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Table 1.

Clinician Interview and Focus Group Participants

Characteristics	Clinician Interviews (n = 20)	Focus Groups (n = 10)
PA = physician’s assistant; NP = nurse-practitioner.
Sex, female	9	4
Practice specialty
Family physicians	5	5
Pediatricians	5	2
Mid-level practitioners (PA, NP)	7	2
Internists	3	1
Total	20	10
Institutional setting
University of New Mexico	9	4
Community Health Center	6	4
Indian Health Service	5	2
Total	20	10

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Table 2.

Comparison of RIOS Net General Membership With RIOS Net Survey Respondents

Characteristics	Network Members (n = 195)	Survey Respondents (n = 146)	P Value
PA = physician’s assistant; NP = nurse-practitioner.
Sex, female, %	55	55	.959
Institutional setting, %
University of New Mexico	29	37
Community Health Centers	32	24
Indian Health Service	36	35
Private practice	3	4	.202
Practice specialty, %
Family physicians	58	57
Pediatricians	19	22
Mid-level (PA, NP)	15	12
General internists	8	9	.779
Location, %
Rural	53	61
Urban	47	39	.163
Years of experience, mean No. (SD)	12.1 (8.2)	11.9 (8.3)	.849

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Table 3.

Factors Influencing the Delivery of Obesity Preventive Counseling

	Factors
Category	Setting the Stage	As the Door Opens
Clinician	Life values  Definitions of success  Training type  Experience  Counseling style  Professional skills  Social/professional networks  Guidelines	Perceived patient receptivity  Presence/absence of a teachable moment
Patient	Motivation: barriers and facilitators to change  Individual/familyResources  Cultural norms	Patient agenda
External	Institutional issues  Practice structure  Community resources	Current practice conditions

Additional Files

Tables

Supplemental Appendixes

Supplemental Appendix 1. Clinician Interview Guide; Supplemental Appendix 2. Survey Responses on Obesity Prevention Counseling (n = 146); Supplemental Appendix 3. Description of Factor Analysis Methods; Supplemental Appendix 4. Results of Factor Analysis of Responses to Survey Questions About Reasons for Preventive Counseling for Obesity.

Files in this Data Supplement:

Supplemental data: Appendix 1 - PDF file, 3 pages 61 KB
Supplemental data: Appendix 2 - PDF file, 3 pages, 136 KB
Supplemental data: Appendix 3 - PDF file, 1 page, 45 KB
Supplemental data: Appendix 4 - PDF file, 1 page, 61 KB
The Article in Brief

The Art and Complexity of Primary Care Clinicians' Preventive Counseling Decisions: Obesity as a Case Study

Andrew L. Sussman , and colleagues

Background Counseling patients about preventing disease and staying healthy is an important part of primary care, but clinicians provide this type of counseling at low rates. In this study, researchers looked at factors that influence clinicians� decisions to provide preventive health counseling. In particular, they focused on counseling patients for obesity.

What This Study Found The decision to provide preventive counseling for obesity is influenced by complex factors in 2 categories: (1) Factors that are fairly stable and unchanging, such as the clinician�s personal values, definitions of success, and the availability of community resources. These factors �set the stage� for the patient visit. (2) Factors that are more dynamic and changing, such as the patient�s agenda for the visit, how receptive the patient is to the proposed counseling, and the presence of special opportunities (�teachable moments�) for counseling. These factors vary with each patient visit.

Implications

Efforts to increase rates of preventive counseling need to focus on the complexity of the primary care visit, rather than on a few isolated elements of the visit.
Clinicians actively manage time during the brief patient visit to maximize the benefits to the patient. Efforts to increase rates of preventive counseling should consider the many competing demands faced by clinicians and patients during the course of a visit.