Nutrition counseling in private practice: attitudes and activities of family physicians

A community approach to cardiovascular disease control is advocated for the United States because of the high disease incidence and prevalence relative to other countries. The goal of this approach is to change nutrition behavior of all members of the community. As part of a program to identify barriers to physician participation, a survey of a random sample of family practice clinical faculty in a midwestern state was made to determine (a) if physicians agree that it is appropriate to give nutritional advice to a patient who came to the clinic for another reason, (b) the proportion of patients given nutritional advice, and (c) the barriers to giving nutritional advice. Most physicians report that giving nutritional advice to patients visiting them for other reasons is considered appropriate, but almost half the physicians give advice about dietary fat, dietary sodium, or dietary fiber to fewer than 20% of their patients. Only about 10% of physicians give advice to more than 80% of their patients. Absence of elevated risk factor levels or nutritional disease is the most common reason for not giving advice. Perceived lack of patient interest and expectation of patient nonadherence are also barriers. Unpalatability of the diet is occasionally a barrier. Cost of the diet is not a consideration. From these data it is concluded that family physicians consider it appropriate to give nutritional advice to patients who are not necessarily seeking it, but the perception that patients do not need or want, and would not follow, the advice inhibits physicians from delivering nutrition messages in private practice.

Feasibility of simulating physicians' judgments of patient severity

This article reports on adopting Gustafson's multiattribute utility method to develop a specific momentary severity index (vis-à-vis severity over time) for nontraumatic chest pain patients. A panel of physicians identified an appropriate set of indicators for the index. Three mathematic models were generated on the basis of these indicators with each model predicting no less than 81% of the variance in overall scores of 96 simulated patients with chest pain. High interrater reliability (0.94) was demonstrated. Congruent validity coefficients between the three model scores and the overall scores vary between 0.71 and 0.92 depending on how the panel physicians are grouped. Results indicate the feasibility of simulating physician judgments regarding patient severity in chest-pain-related cases.

Systematic impact of the state on CEO tenure

Using information from the literature on both for-profit industrial corporations and nonprofit community hospitals, a path model is constructed to show the effect of the state on CEO tenure at state-owned university hospitals. Results indicate that CEOs' lack of managerial influence and control over competition adversely affects their tenure at these institutions, even when the financial viability of the university hospital is not at stake.

Health-specific family coping index for noninstitutional care

We report on attempts to improve the Richmond/Hopkins Family Coping Index. Factor analysis showed that revised operational guidelines for using the index probably contributed to a significantly higher per cent of variance explained by the index (83 per cent versus 59 per cent). Interrater reliability was high (greater than or equal to .97). Correlation between this index and another coping index was also high (.94). Results support the continued use of the Family Coping Index--with new instructions--to assess patient/family coping.

Perceived palatability of the prudent diet: results of a dietary demonstration for physicians

"Product sampling" is an effective marketing strategy which lowers consumer buying resistance by providing a free sample of the product for the consumer to test. We used this strategy to demonstrate the palatability of the prudent diet (30-35% of calories from total fats, less than 10% from saturated fats, less than 3 g sodium, and increased fiber) to physicians attending a 5-day family practice continuing medical education conference. The effect of the intervention was evaluated with pre- and postintervention questionnaires and a 20% random sample of participants was surveyed 1 year later. The proportion of physicians who reported that they considered the diet to be "very palatable" rose from 26% before the demonstration to 64% after the demonstration. Only 5% of the physicians did not report a favorable response to the demonstration. Sixty-two percent of the physicians reported that the diet was better than expected, and 82% reported that the demonstration encouraged them to recommend the diet to their patients. One year after the intervention 60% considered the diet "very palatable" and 55% reported that the demonstration stimulated them to increase their dietary intervention activities. These data suggest that serving the prudent diet at continuing medical education programs helps to remove prejudices about the diet and encourages physicians to recommend the diet to their patients.

Primary nursing in an organizational context

This article analyzes primary nursing critically and comprehensively. Synthesizing past and present data, the authors suggest a new definition for primary nursing that takes the organizational context into consideration. They illustrate how organizations influence the effectiveness of primary nursing care. The documented information presented here will save nursing administrators hours of reading and analyzing, and will help them make informed decisions about primary nursing.