Health behavior counseling in primary care: provider-reported rate and confidence.

BACKGROUND AND OBJECTIVES: This study's purpose was to identify variables associated with primary care providers' self-reported rate of health behavior change counseling and confidence in counseling abilities. Of particular interest was the association of provider personal health behavior with reported rate of counseling and confidence in counseling abilities. METHODS: Surveys were mailed to primary care providers. Self-report items assessed rate of health behavior change counseling, perceived importance of counseling, extent of counseling training, confidence in counseling abilities, and clinician personal health behavior. RESULTS: One hundred providers completed the survey, with 31% reporting difficulty counseling patients on a health behavior that they struggle with themselves. Provider type (eg, nurse or physician) and extent of training in health behavior change counseling were significantly associated with reported rate of counseling in a multiple regression model (adjusted R2=.30). Years in practice, extent of training, and importance of counseling were significantly associated with confidence in counseling in a multiple regression model (adjusted R2=.31). CONCLUSIONS: Some providers report difficulty counseling patients on behaviors that they struggle with themselves. Extent of training in health behavior counseling appears to be particularly important to both provider-reported rate of counseling and confidence to counsel.

The prevention and treatment of pertussis.

Since 2004, more than 25,000 cases of pertussis have been reported in the United States each year. Symptoms in adults range from mild cough to severe persistent cough with posttussive emesis. The characteristic paroxysmal cough (whoop) may be absent, and the diagnosis is often missed, especially when the cough is mild. The most useful diagnostic test to confirm pertussis is a polymerase chain reaction assay of a nasopharyngeal swab sample. Patients are infectious for three weeks from the cough onset. Antibiotic treatment, preferably with macrolide antibiotics, is indicated during this time for pertussis treatment and prophylaxis. In 2005, two new acellular pertussis vaccines were licensed: one (Boostrix) for patients aged 10 to 18 years and another (Adacel) for patients aged 11 to 64 years.

Efficacy of a simple, low-cost educational intervention in improving knowledge about risks and benefits of screening mammography.

OBJECTIVES: To assess the efficacy of a minimal cost and involvement educational intervention in improving women's knowledge about screening mammography and to explore patient perceptions of the educational intervention. PARTICIPANTS AND METHODS: During the study period (March 10, 2005, to July 1, 2005), 1446 participants in the Mayo Mammography Health Study scheduled for a mammogram within 4 weeks at the Mayo Clinic in Rochester, Minn, were randomized to 2 study groups and mailed surveys about mammograms. The 2 groups received separate surveys; both surveys contained knowledge-based questions about mammography, but the educational intervention group survey also contained qualitative questions that assessed the educational pamphlets. RESULTS: Of the 668 surveys returned (responders), 248 (34.4%) were from the control group, and 420 (58.3%) were from the intervention group. Approximately 80% of responders had had more than 7 prior mammograms. Significant increases in knowledge about mammography were found in the educational intervention compared with the control group on questions regarding age to begin screening mammography (67.9% vs 54.4%; P < .001), recommended frequency of mammograms (86.4% vs 75.4%; P < .001), overall reduction in mortality due to screening mammography (55.2% vs 8.9%; P < .001), and proportions of women who required follow-up mammograms (35.5% vs 14.9%; P < .001) or biopsy (59.5% vs 13.3%; P < .001). Qualitative data results indicated that most women who received the educational intervention found the pamphlets helpful and informative despite having had many previous mammograms. CONCLUSION: The results suggest that providing women scheduled for screening mammograms with physician-approved educational material before their appointment significantly increases knowledge about screening mammography, risks and benefits, and possible follow-up.