Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?

Jay, Melanie; Gillespie, Colleen; Schlair, Sheira; Sherman, Scott E.; Kalet, Adina

doi:10.1186/1472-6963-10-159

Cited by 129 publications

(121 citation statements)

References 39 publications

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“…Our finding that few individuals with obesity make it to the end of the cascade suggests that there is significant unmet need for obesity care at the population level. Engaging with this last step is essential to gaining access to managed, effective care and can result in a myriad of treatment outcomes, including behavioral modification, pharmacotherapy, bariatric surgery, and/or referral to another care provider 17, 18, 19, 20, 21. Our findings thus highlight the need for physicians to engage in conversation about obesity treatment at routine clinical visits, even when patients are not seeking obesity care.…”

Section: Discussionmentioning

confidence: 83%

Prevalence and Determinants of Engagement with Obesity Care in the United States

Stokes

Collins

Grant³

et al. 2018

Obesity

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ObjectiveMedical management of obesity can result in significant weight loss and reduce the burden of obesity‐related complications. This report employs a new conceptual model to quantify engagement with obesity care and associated determinants in the US adult population.MethodsEngagement with obesity care was conceptualized as a cascade comprising 5 successive steps: perceiving oneself as overweight, desiring to lose weight, attempting weight loss, seeking care from a health care professional for obesity, and seeking care from a physician specifically.ResultsAmong adults with obesity, 7.3% did not perceive themselves as overweight, 1.5% perceived themselves as overweight but had no desire to lose weight, 29.9% wanted to lose weight but did not try in the last year, 51.3% tried to lose weight but did not consult a health professional, and 6.4% sought help for weight loss from a health professional but not a physician, implying that 96.4% of the population with obesity had an unmet need for obesity care.ConclusionsThis analysis provides new insight into the most common points along the cascade at which disengagement occurs and can inform efforts to improve uptake of obesity‐related health care services.

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Section: Discussionmentioning

confidence: 83%

Prevalence and Determinants of Engagement with Obesity Care in the United States

Stokes

Collins

Grant³

et al. 2018

Obesity

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“…Physician use of a patient-centered approach has been shown to be associated with patient intention to exercise. 20 Exploring ambivalence is an important feature of patient-centered physical activity discussions. Patient-centered communication skills may be particularly helpful when physical activity is discussed in the context of weight management, as it is common for patients and physicians to have discrepant perceptions regarding weight.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier work examining the 5As for smoking found that patients contributed to accomplishing some of the 5As 17,20 ; therefore, the coding scheme for the 5As for physical activity incorporated patient contribution to accomplishing the 5As. Drawing from a sample of 135 offi ce visits with audio-recorded discussions of physical activity, we used the preliminary template to code an initial sample of 10 discussions.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Physical Activity Counseling in Primary Care Using Direct Observation of the 5As

Carroll

Antognoli

Flocke³

2011

The Annals of Family Medicine

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BACKGROUND The 5As (ask, advise, assess, assist, arrange) are recommended as a strategy for brief physical activity counseling in primary care. There is no reference standard for measurement, however, and patient participation is not well understood. This study's objectives were to (1) develop a coding scheme to measure the 5As using audio-recordings of primary care visits and (2) describe the degree to which patients and physicians accomplish the 5As. METHODSWe developed a coding scheme using previously published defi nitions of the 5As, direct-observation measures, and evaluation of audio-recorded discussions of physical activity. We applied the coding scheme to 361 audiorecorded visits by patients reporting low levels of physical activity and 28 physicians in northeast Ohio. RESULTSThe coding scheme achieved good inter-rater agreement for each of the 5As (κ = 0.62-1.0). A total of 135 visits included discussion of physical activity. Although ask tasks occurred in 91% of visits, it infrequently elicited suffi cient detail about current activity. Patient readiness to change physical activity (assess) was infrequently directly elicited by the physician (24%), but readiness was commonly expressed by the patient in response to an assessment of current level of physical activity (53%). Ambivalence was infrequently followed by physician assistance (49%).CONCLUSIONS Our newly developed measure showed that (1) physicians infrequently assess patient readiness to change, (2) patient expressions of ambivalence are common, and (3) specifi c mention of recommended guidelines for exercise is nearly absent. Future work should increase clinician skills in exploring ambivalence and readiness to change, as well as improve explicit mention of recommended guidelines for physical activity.

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“…46 Use of the 5 A's is associated with change in health behaviors across diverse populations and health behaviors. [47][48][49] Because the 5 A's model covers the key elements of selfmanagement support, it presents a guiding conceptual framework for evaluating and implementing behavioral change counseling interventions in chronic disease management (Clinical Scenario 3). 50 Thus, this framework could be easily adapted to facilitate a person-centered approach to address medication adherence.…”

Section: Motivational Interviewing and Counselingmentioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

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Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?

Cited by 129 publications

References 39 publications

Prevalence and Determinants of Engagement with Obesity Care in the United States

Prevalence and Determinants of Engagement with Obesity Care in the United States

Evaluation of Physical Activity Counseling in Primary Care Using Direct Observation of the 5As

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

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