Physical activity counseling in primary care: the challenge of effecting behavioral change.
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Counseling↗
Biomedical subjects
C C Wee
Publications and source records attributed to C C Wee.
Relationship between smoking and weight control efforts among adults in the united states.
BACKGROUND: The effect of weight control concerns on smoking among adults is unclear. We examined the association between smoking behavior and weight control efforts among US adults. METHODS: A total of 17 317 adults responded to the Year 2000 Supplement of the 1995 National Health Interview Survey (83% combined response rate). Respondents provided sociodemographic and health information, including their smoking history and whether they were trying to lose weight, maintain weight, or gain weight. RESULTS: Rates of smoking were lower among adults who were trying to lose or maintain weight than among those not trying to control weight (25% vs 31%; P<.001). After adjustment for sex, race, education, income, marital status, region of the country, and body mass index, the relationship between trying to lose weight and current smoking varied according to age. Among adults younger than 30 years, those trying to lose weight were more likely to smoke currently (odds ratio, 1.36 [95% confidence interval, 1.09-1.70]), whereas older adults trying to lose weight were as likely or less likely to smoke compared with adults not trying to control weight. After adjustment, smokers of all ages who were trying to lose weight were more likely to express a desire to quit smoking. Results were similar after stratification by sex and body mass index. CONCLUSIONS: Adults younger than 30 years are more likely to smoke if they are trying to lose weight. However, smokers of all ages who are trying to lose weight are more likely to want to stop smoking. Patients' weight control efforts should not discourage clinicians from counseling about smoking cessation. Education about smoking and healthy weight control methods should target young adults.
Adult↗
Influence of financial productivity incentives on the use of preventive care.
PURPOSE: We examined whether physician factors, particularly financial productivity incentives, affect the provision of preventive care. SUBJECTS AND METHODS: We surveyed and reviewed the charts of 4,473 patients who saw 1 of 169 internists from 11 academically affiliated primary care practices in Boston. We abstracted cancer risk factors, comorbid conditions, and the dates of the last Papanicolaou (Pap) smear, mammogram, cholesterol screening, and influenza vaccination. We obtained physician information including the method of financial compensation through a mailed physician survey. We used multivariable logistic regression to examine the association between physician factors and four outcomes based on Health Plan Employer Data and Information Set (HEDIS) measures: (1) Pap smear within the prior 3 years among women 20 to 75 years old; (2) mammogram in the prior 2 years among women 52 to 69 years old; (3) cholesterol screening within the prior 5 years among patients 40 to 64 years old; and (4) influenza vaccination among patients 65 years old and older. All analyses accounted for clus-tering by provider and site and were converted into adjusted rates. RESULTS: After adjustment for practice site, clinical, and physician factors, patients cared for by physicians with financial productivity incentives were significantly less likely than those cared for by physicians without this incentive to receive Pap smears (rate difference, 12%; 95% confidence interval [CI]: 5% to 18%) and cholesterol screening (rate difference, 4%; 95% CI: 0% to 8%). Financial incentives were not significantly associated with rates of mammography (rate difference, -3%; 95% CI: -15% to 10%) or influenza vaccination (rate difference, -13%; 95% CI: -28% to 2%). CONCLUSIONS: Our findings suggest that some financial productivity incentives may discourage the performance of certain forms of preventive care, specifically Pap smears and cholesterol screening. More studies are needed to examine the effects of financial incentives on the quality of care, and to examine whether quality improvement interventions or incentives based on quality improve the performance of preventive care.
Adult↗
Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care?
BACKGROUND: Compared with thinner women, obese women have higher mortality rates for breast and cervical cancer. In addition, obesity leads to adverse social and psychological consequences. Whether obesity limits access to screening for breast and cervical cancer is unclear. OBJECTIVE: To examine the relation between obesity and screening with Papanicolaou (Pap) smears and mammography. DESIGN: Population-based survey. SETTING: United States. PARTICIPANTS: 11 435 women who responded to the "Year 2000 Supplement" of the 1994 National Health Interview Survey. MEASUREMENTS: Screening with Pap smears and mammography was assessed by questionnaire. RESULTS: In women 18 to 75 years of age who had not previously undergone hysterectomy (n = 8394), fewer overweight women (78%) and obese women (78%) than normal-weight women (84%) had had Pap smears in the previous 3 years (P < 0.001). After adjustment for sociodemographic information, insurance and access to care, illness burden, and provider specialty, rate differences for screening with Pap smears were still seen among overweight (-3.5% [95% CI, -5.9% to -1.1%]) and obese women (-5.3% [CI, -8.0% to -2.6%]). In women 50 to 75 years of age (n = 3502), fewer overweight women (64%) and obese women (62%) than normal-weight women (68%) had had mammography in the previous 2 years (P < 0.002). After adjustment, rate differences were -2.8% (CI, -6.7% to 0.9%) for overweight women and -5.4% (CI, -10.8% to -0.1%) for obese women. CONCLUSIONS: Overweight and obese women were less likely to be screened for cervical and breast cancer with Pap smears and mammography, even after adjustment for other known barriers to care. Because overweight and obese women have higher mortality rates for cervical and breast cancer, they should be targeted for increased screening.
Adolescent↗
Physician counseling about exercise.
CONTEXT: The increase in sedentary lifestyle may contribute to the rise in obesity nationally. Although guidelines suggest that physicians counsel all patients about exercise, physicians counsel only a minority of their patients. Whether patient factors influence physician counseling is not well established. OBJECTIVES: To examine and to identify factors associated with exercise counseling by US physicians. DESIGN AND SETTING: National population-based supplemental (Year 2000) survey to the 1995 National Health Interview Survey. PARTICIPANTS: Of the 17317 respondents to the Year 2000 supplemental survey, 9711 adults had seen a physician in the previous year, and 9299 responded when asked about physician counseling on exercise. MAIN OUTCOME MEASURE: Physician counseling to begin or to continue to exercise. RESULTS: Of 9299 respondents, 34% reported being counseled about exercise at their last visit. After adjustment for other sociodemographic and clinical factors, women were slightly more likely to be counseled, with an adjusted odds ratio (AOR) of 1.15 (95% confidence interval [CI], 1.02-1.29). Physicians counseled older patients (>30 years) more often than younger patients; those aged 40 to 49 years were counseled most often (AOR, 1.71 [95% CI, 1.34-2.20]). Patients with incomes above $50000, those with higher levels of physical activity, college graduates, and patients who were overweight to obese (body mass index: 25 to > or =30 kg/m2) were more likely to be counseled, as were patients with cardiac disease (AOR, 1.81 [95% CI, 1.52-2.14]) and diabetes (AOR, 1.87 [95% CI, 1.46-2.38]). Counseling did not vary by physician specialty or patient race. CONCLUSION: The rate of physician counseling about exercise is low nationally. Physicians appear to counsel as secondary prevention and are less likely to counsel patients at risk for obesity. The failure to counsel younger, disease-free adults and those from lower socioeconomic groups may represent important missed opportunities for primary prevention.
Adult↗
Risk for valvular heart disease among users of fenfluramine and dexfenfluramine who underwent echocardiography before use of medication.
BACKGROUND: Because uncontrolled echocardiographic surveys suggested that up to 30% to 38% of users of fenfluramine and dexfenfluramine had valvular disease, these drugs were withdrawn from the market. OBJECTIVE: To determine the risk for new or worsening valvular abnormalities among users of fenfluramine or dexfenfluramine who underwent echocardiography before they began to take these medications. DESIGN: Cohort study. SETTING: Academic primary care practices. PATIENTS: 46 patients who used fenfluramine or dexfenfluramine for 14 days or more and had echocardiograms obtained before therapy. MEASUREMENTS: Follow-up echocardiography. The primary outcome was new or worsening valvulopathy, defined as progression of either aortic or mitral regurgitation by at least one degree of severity and disease that met U.S. Food and Drug Administration criteria (at least mild aortic regurgitation or moderate mitral regurgitation). RESULTS: Two patients (4.3% [95% CI, 0.6% to 14.8%]) receiving fenfluramine-phentermine developed valvular heart disease. One had baseline bicuspid aortic valve and mild aortic regurgitation that progressed to moderate regurgitation. The second patient developed new moderate aortic insufficiency. CONCLUSION: Users of diet medications are at risk for valvular heart disease. However, the incidence may be lower than that reported previously.
Adult↗