Physician discussion about social activities in primary care encounters with older adults.

OBJECTIVE: Involvement in social activities is linked to positive health outcomes. This study focused on the prevalence of social activity discussions during the primary care medical encounter, and examined how patient, physician, and contextual factors were associated with discussions between physicians and older patients. METHODS: The research was a secondary analysis of 434 videotapes recorded during primary care medical visits between 1998 and 2000 in outpatient clinics. Recordings were coded to identify a number of variables related to patient, physician, and companion characteristics, physician discussion on various topics, and quality of the physician's interaction with the patient. RESULTS: Physicians discussed social activity in only 31% of medical encounters. Variables significantly associated with social activity discussions included patient and physician race/ethnicity, physician age group, physician supportiveness, and the geographical site of the visit. CONCLUSION: Results support the inclusion of discussion and counseling about social activities in medical encounters with older patients. Family physicians will likely experience improved patient satisfaction, and geriatric patients can potentially reap health benefits that improve both quality of life and medical outcomes. Additional research is needed to understand more fully the correlates and benefits of social activity discussion during the medical encounter.

Prevalence and correlates of doctor-geriatric patient lifestyle discussions: analysis of ADEPT videotapes.

BACKGROUND: This study identifies the prevalence and correlates of physician-geriatric patient discussions about physical activity and nutrition lifestyle behaviors. METHODS: Between August 1998 and July 2000, 423 older patient visits to 36 physicians were videotaped in three different primary care settings. The patient sample was primarily white, female, well-educated, and financially sufficient, although 12.7% of the encounters occurred in an inner city clinic. The major dependent variable-lifestyle discussion-is based on observations of physician behavior. Descriptive and multivariate logistic regression analyses were conducted in 2004. RESULTS: Nutrition talk was most prevalent, occurring in almost half the encounters (48.2%) followed by physical activity discussions (39.2%) then conjoint mention (22%). Discussions were significantly less likely to occur in acute visits. While ethnicity, gender, and length of visit were not significantly related, physician interaction style and patient vitality and education were significant predictors in the multivariate analyses. CONCLUSIONS: Given the impact of lifestyle behaviors on myriad health outcomes, the current prevalence rates of physician discussion, while higher than in many previous studies, remain sub-optimal. Practical assessment tools, training in behavioral counseling, and reimbursement incentives are recommended strategies for raising physical activity and nutrition discussion prevalence in primary care settings.