Direct observation of health-habit counseling of adolescents

Objectives: To determine the rate of health-habit counseling of adolescents seeing community family physicians and to identify the factors associated with the delivery of recommended preventive counseling services. Design: Cross-sectional multimethod study emphasizing direct observation of patient visits. Setting: Community family practices in northeast Ohio. Patients or Other Participants: Adolescents (n = 445) aged 11 to 21 years w ho were being seen for outpatient visits to community family physicians (n = 119) during 2 days of observation by trained research nurses. Main Outcome Measurer Direct observation of the delivery of clinical preven tive counseling services recommended by the Guidelines for Adolescent Preve ntive Services. Results: During the 445 visits made by adolescents, the most frequently del ivered counseling service was exercise advice (13%). At least 1 health-habi t counseling service was delivered during 38% of visits. In multivariable a nalyses, older patient age was strongly associated with increased service d elivery. Visits for well care, longer visits, and new patient visits were a lso associated with the provision of counseling. Visits including preventiv e counseling services were on average 2.5 minutes longer than visits withou t preventive counseling. Conclusions: The rates of delivery of preventive counseling services in cli nical practice were low, raising concern about the feasibility of current r ecommendations. The practical implementation of prevention guidelines may r equire a greater use of well-care visits and longer patient visits than are currently used in community family practice.