THE COUNSELING PRACTICES OF INTERNISTS
THE COUNSELING PRACTICES OF INTERNISTS
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DOI：
10.7326/0003-4819-114-1-54
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发表时间：
1991-01-01
影响因子：
39.2
通讯作者：
SCHWARTZ, JS
中科院分区：
文献类型：
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作者：
LEWIS, CE;CLANCY, C;SCHWARTZ, JS
目标：确定一组内科医生在吸烟、运动、饮酒和安全带使用方面的咨询实践，并确定医生的个人健康习惯与其咨询实践之间的关联。设计：对代表美国所有地区的 21 个地区的美国内科医师学会成员和研究员进行随机分层抽样。由于该组中女性比例相对较小，因此样本被过度抽样。背景：医生诊所。参与者：1349 名内科医生（学院成员或研究员）返回问卷，回复率为 75%； 52% 的人将自己定义为普通内科医生。 干预措施：使用调查问卷来获取有关内科医生吸烟、饮酒和安全带使用情况及其体力活动水平的信息。获得了关于用于咨询的指征和针对这四种习惯的咨询的积极性的数据。测量和主要结果：使用双变量和逻辑回归分析来比较内科医生亚组在使用各种咨询指征和咨询彻底性方面的倾向。与专科医生相比，通才更有可能为所有有风险的患者至少提供一次咨询，并且在咨询中更加积极。 90% 的受访者向所有吸烟的患者提供了咨询，但 64.5% 的受访者从未讨论过安全带的使用。目前，这些内科医生中只有 3.8% 吸烟，11.3% 每天饮酒，38.7% 极度或相当活跃，87.3% 全部或大部分时间使用安全带。在男性内科医生中，除了饮酒之外，每一种习惯的个人健康习惯都与为患者提供咨询密切相关。例如，不吸烟的内科医生更有可能为吸烟者提供建议，而身体活跃的内科医生更有可能为锻炼提供建议。在女性内科医生中，身体活动非常活跃与向更多患者提供有关运动和饮酒的咨询有关。结论：这些内科医生自我报告的咨询水平较低，表明需要进一步强调这些技能的培训。个人实践和专业实践之间的联系表明，医学院和家庭工作人员培训计划应该支持未来内科医生的健康促进活动。
Objectives: To determine the counseling practices of a group of internists in the areas of smoking, exercise, and alcohol and seat belt use, and to determine the associations among physicians' personal health habits and their counseling practices.Design: A random stratified sample of members and fellows of the American College of Physicians in 21 regions selected to represent all areas of the United States. Because of the relatively small proportion of women in this group, they were oversampled.Setting: Physicians' practices.Participants: One thousand three hundred and forty-nine internists (members or fellows of the College) returned questionnaires, for a response rate of 75%; 52% defined themselves as general internists.Interventions: A questionnaire was used to obtain information on internists' use of cigarettes, alcohol, and seat belts and their level of physical activity. Data were obtained on the indications used for counseling and the aggressiveness of counseling about each of these four habits.Measurements and Main Results: Bivariate and logistic regression analyses were used to compare the tendencies of internist subgroups both in using various indications for counseling and in the thoroughness of counseling. Generalists were more likely than specialists to counsel at least once all patients who were at risk and to be more aggressive in counseling. Ninety percent of respondents counseled all of their patients who smoked, but 64.5% never discussed the use of seat belts. Only 3.8% of these internists currently smoked cigarettes, 11.3% drank alcohol daily, 38.7% were extremely or quite active, and 87.3% used seat belts all or most of the time. Among men internists, for every habit except alcohol use, personal health practices were substantially associated with counseling patients; for example, nonsmoking internists were more likely to counsel smokers, and very physically active internists were more likely to counsel about exercise. Among women internists, being very physically active was associated with counseling more patients about exercise and alcohol use.Conclusions: The low level of self-reported counseling among these internists suggests that further emphasis on training in these skills is needed. The association between personal and professional practices suggests that medical schools and housestaff training programs should support health promotion activities for future internists.