The Relationship Between Patient Income and Physician Discussion of Health Risk Behaviors

Taira, Deborah A.; Safran, Dana Gelb; Seto, Todd B.; Rogers, William H.; Tarlov, Alvin R.

doi:10.1001/jama.1997.03550170042030

Cited by 97 publications

(41 citation statements)

References 46 publications

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“…15 In spite of the growing obesity problem, half or more of obese patients in the United States do not report being counseled about weight loss by their physicians. [18][19][20][21][22][23] Reported counseling from a health care professional about weight, diet, or exercise among overweight and obese adults is lower for some racial/ethnic minorities, 23 persons with lower income 24,25 or less education, 20,21,24 younger persons, 23,24 and men 21,23 than their counterparts.…”

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confidence: 99%

Trends in professional advice to lose weight among obese adults, 1994 to 2000

et al. 2005

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Context: Obesity is a fast‐growing threat to public health in the U.S., but information on trends in professional advice to lose weight is limited. Objective: We studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults. Design and Participants: We used the Behavioral Risk Factor Surveillance System, a cross‐sectional prevalence study, from 1994 (n=10,705), 1996 (n=13,800), 1998 (n=18,816), and 2000 (n=26,454) to examine changes in advice reported by obese adults seen for primary care. Measurements: Self‐reported advice from a health care professional to lose weight. Results: From 1994 to 2000, the proportion of obese persons receiving advice to lose weight fell from 44.0% to 40.0%. Among obese persons not graduating from high school, advice declined from 41.4% to 31.8%; and for those with annual household incomes below $25,000, advice dropped from 44.3% to 38.1%. In contrast, the prevalence of advice among obese persons with a college degree or in the highest income group remained relatively stable and high (>45%) over the study period. Conclusions: Disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. There is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence‐based weight loss interventions, especially those that target groups most at risk for obesity.

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confidence: 99%

Trends in professional advice to lose weight among obese adults, 1994 to 2000

et al. 2005

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“…16 The finding that the topic of physical activity was raised 41% of the time was somewhat higher than previously reported in other studies. 7,20,36 Yet the question of how much counseling is sufficient, and by whom, is an area of active debate. If we consider that the majority of our participants (78%) were not meeting recommended levels of activity and/or were either overweight or obese (75%), then one could argue that the observed rate of counseling was inadequate to achieve national goals.…”

Section: Discussionmentioning

confidence: 99%

“…[33][34][35] Although data from underserved populations are lacking, one study showed that low-income patients with whom physical activity was discussed were significantly more likely to attempt behavior change than were high-income patients. 36 Some data suggest that the last 2 As (Assist and Arrange) may be better achieved by collaboration with allied health educators, community programs, or other health care staff resources given the competing demands that primary care clinicians face. 6,15 Because strong empirical data to support this are lacking, especially among underserved populations, studies should address the role of ancillary professionals in the delivery of counseling and the effect on activity outcomes.…”

Section: Assistmentioning

confidence: 99%

Clinician-Patient Communication About Physical Activity in an Underserved Population

Carroll

Fiscella

Meldrum

et al. 2008

The Journal of the American Board of Family Medicine

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Background: The 5A (Ask, Advise, Agree, Assist, Arrange) model, used to promote patient behavior changes in primary care, can also be applied to physical activity. Our goal was to assess primary care physicians' use of the 5A model in discussions with underserved populations about physical activity.Methods: We analyzed 51 audio-recorded, transcribed office visits on randomly selected patient care days and after-visit patient surveys with adults in 2 community health centers in Rochester, New York.Results: The patient sample was 51% African-American and predominantly female (70%), with the majority having a high school-level education or less (66%) and an annual household income <$39,000 (57%). Physical activity was discussed during 19 of the 51 visits, which included 16 (84%) visits with "Ask"; 10 (53%) with "Advise"; 4 (21%) with "Agree"; 5 (26%) with "Assist"; and 0 with "Arrange" statements. Most discussions of physical activity contained several Ask or Advise statements but few Agree, Assist, or Arrange statements.Conclusion

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“…Taira et al showed that physicians were more likely to discuss diet and exercise with high-income patients than those from a low-income group; however, they were more likely to discuss smoking with low-income patients. 12 A rich international literature highlights that a patient's inclination to participate in medical decision making, notably on cardiovascular disease management, varies by characteristics, such as age and education, but also by sex, coping style, and severity of condition. [13][14][15][16][17][18] This emphasises the health disparities, notably concerning the management of cardiovascular risk factors in the context of primary care.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Do doctors and patients agree on cardiovascular-risk management recommendations post-consultation? The INTERMEDE study

Schieber

Kelly-Irving²,

Rolland³

et al. 2011

Br J Gen Pract

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Understanding interactions between patients and GPs is potentially important for optimising communication during consultations and improving health promotion, notably in the management of cardiovascular risk factors. [1][2][3] Little is known of the role played by these interactions in the maintenance or production of health disparities. 4-6The objective of this study was to explore the concordance between GPs and patients' declarations on the management of cardiovascular risk factors, and to explore whether potential disagreement was linked to patients' educational level. METHOD Study designThe design and methods of the INTERMEDE study's quantitative phase (Figure 1) AimTo explore the agreement between physicians and patients on the management of cardiovascular risk factors, and whether potential disagreement is linked to the patient's educational level. Design of studyINTERMEDE is a cross-sectional study with data collection occurring at GPs' offices over a 2-week period in October 2007 in France. MethodData were collected from both patients and doctors respectively via pre-and post-consultation questionnaires that were 'mirrored', meaning that GPs and patients were presented with the same questions. ResultsThe sample consisted of 585 eligible patients (61% females) and 27 GPs. Agreement between patients and GPs was better for tangible aspects of the consultation, such as measuring blood pressure (κ = 0.84, standard deviation [SD] = 0.04), compared to abstract elements, like advising the patient on nutrition (κ = 0.36, SD = 0.04), and on exercise (κ = 0.56, SD = 0.04). Patients' age was closely related to level of education: half of those without any qualification were older than 65 years. The statistical association between education and agreement between physicians and patients disappeared after adjustment for age, but a trend remained. ConclusionThis study reveals misunderstandings between patients and GPs on the content of the consultation, especially for health-promotion outcomes. Taking patients' social characteristics into account, notably age and educational level, could improve mutual understanding between patients and GPs, and therefore, the quality of care.

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The Relationship Between Patient Income and Physician Discussion of Health Risk Behaviors

Cited by 97 publications

References 46 publications

Trends in professional advice to lose weight among obese adults, 1994 to 2000

Trends in professional advice to lose weight among obese adults, 1994 to 2000

Clinician-Patient Communication About Physical Activity in an Underserved Population

Do doctors and patients agree on cardiovascular-risk management recommendations post-consultation? The INTERMEDE study

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