Article

Patient recall of receiving lifestyle advice for overweight and hypertension from their General Practitioner

Queens University Belfast, UK.
BMC Family Practice (Impact Factor: 1.74). 02/2010; 11(1):8. DOI: 10.1186/1471-2296-11-8
Source: PubMed

ABSTRACT Overweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. General practitioners (GPs) in Australia have access to over 90% of the population in the course of a year and therefore, the general practice setting may be ideal to assist patients with lifestyle change for weight management and hypertension. The present study aimed to determine the proportion of overweight/obese patients that recalled receiving advice by their GP to make lifestyle changes for weight loss. Recall of advice received by hypertensive patients to reduce salt intake was also measured.
A face to face survey was conducted on a representative sample (urban, suburban and rural) of South Australian residents. Respondents provided information on height and weight (self-report), whether they had received lifestyle advice from their GP for weight loss, and for those with self reported hypertension if they had received advice to reduce dietary salt.
The sample included 2947 South Australian adult residents (58% female; BMI (mean (SD)), 26.6 (5.3) kg/m2; age, 50.7 (18.0) years). Ninety-six percent had visited their GP in the past 12 months. Forty-one percent of males and 25% of females were overweight and 19% of males and 20% of females were obese. Twenty-seven percent of overweight/obese respondents reported receiving lifestyle advice for weight loss purposes. Of the 33% who reported they had hypertension, 34% reported receiving advice to reduce salt intake.
Less than 1/3 of overweight/obese patients reported that they had received lifestyle advice that could assist with weight loss from their GP. About a third of respondents with hypertension reported that they received advice to reduce salt intake. There are potentially missed opportunities in which GPs could provide re-enforcement of benefits of lifestyle changes with respect to weight and blood pressure control.

Full-text

Available from: Alison Booth, Apr 27, 2015
0 Followers
 · 
88 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients. We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity. Consenting adult patients (n = 1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n = 51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n = 107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs. Sensitivity for GP assessment was 63 % [95 % CI 57-69 %], specificity 89 % [95 % CI 85-92 %], PPV 87 % [95 % CI 83-90 %] and NPV 69 % [95 % CI 65-72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1-2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2-2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2-8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07-0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1-0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity. GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented.
    Journal of General Internal Medicine 10/2013; 29(2). DOI:10.1007/s11606-013-2637-4 · 3.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Primary care providers should counsel overweight patients to lose weight. Rates of self-reported, weight-related counseling vary, perhaps because of self-report bias. We assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. We audio-recorded encounters between physicians (n = 40) and their overweight/obese patients (n = 461) at 5 community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters containing weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%), but when weight was not discussed, patients and physicians were more inaccurate and incongruent (patients, 36%; physicians, 44%; 28% congruence). Physicians who were less comfortable discussing weight were more likely to misreport that weight was discussed (odds ratio, 4.5; 95% confidence interval, 1.88-10.75). White physicians with African American patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio, 0.30; 95% confidence interval, 0.13-0.69). Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. Physicians' overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions.
    The Journal of the American Board of Family Medicine 01/2014; 27(1):70-7. DOI:10.3122/jabfm.2014.01.130110 · 1.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To enhance guideline-based non-surgical management of osteoarthritis, a multidisciplinary stepped care strategy has been implemented in clinical practice. This study aims to describe health care use after implementation of this strategy and identify factors related to such use at multiple levels. Methods: For this 2-year observational prospective cohort, patients with symptomatic hip or knee osteoarthritis were included by their general practitioner. Activities, aligned to patients and health care providers, were executed to implement the strategy. Health care use was described as the cumulative percentage “users” for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Results: 313 patients were included by 70 general practitioners of 38 practices. Their mean age was 64 years (SD=10), 120 (38%) were male. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients respectively. 14% of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis", and having limitations in functioning were recurrently identified as determinants of health care use. Conclusion: After implementation of the stepped care strategy, most recommended non-surgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more effort to encourage patients with a passive coping style to use non-surgical modalities. © 2013 American College of Rheumatology.
    10/2013; DOI:10.1002/acr.22222