Health habit counseling amidst competing demands - Effects of patient health habits and visit characteristics

OBJECTIVE. This study assesses the effects of competing demands, such as po or health habits or new medical problems, on health-habit counseling during a primary care visit. METHODS. We sun eyed a consecutive sample of 1,259 patients visiting primar y care clinicians at an academic VA medical center. Before the visit, patie nts reported their health status, health habits, and sociodemographics; imm ediately after the visit, patients reported reasons for the visit and wheth er they had been counseled about specific health habits. We scored visit ac uity ranging from visits for unscheduled walk-in care or new medical proble ms to scheduled visits for check-ups or old problems. We defined counseling "triggers" as clinical indications for counseling about particular health habits (eg, smoking). We developed a logistic model predicting primary care provider counseling during a visit. RESULTS. Over two-thirds of patients (68.9%) received some health habit cou nseling. Controlling for other independent variables, patients with more tr iggers were more likely to report being counseled. Counseling rates went up as visit acuity went down; patients with the lowest visit acuity having 67 % greater odds of being counseled than patients with the highest visit acui ty. CONCLUSIONS. Physicians set priorities for health-habit counseling during a visit based on patients' health habit problems or triggers; whether the vi sit is scheduled or walk-in; and whether the patient has new or acute probl ems. Future research about primary care performance of health habit counsel ing should account for these patient and visit characteristics, and prevent ion-oriented health care organizations should ensure access to scheduled "c heck-up" visits.