Does provider prevention orientation influence female patients' preventive practices?

Weight management perceptions and clinical practices among gynaecology providers caring for reproductive-aged patients

OBJECTIVE

Research suggests that patient and provider conversations about healthy eating and physical activity behaviours may lead to patients' increased health behaviours, access to dietary and physical activity resources, and weight management. The American College of Obstetrics and Gynecology (ACOG) has a number of weight management intervention options, but it is unclear if providers have conversations about intervention options with their patients who are of reproductive age. The purpose of this work was to evaluate the degree to which gynaecology healthcare providers offer the weight management intervention options as recommended by ACOG.

METHODS

Cross-sectional study of gynaecology providers in Southwest Virginia utilizing an electronic survey to identify weight management perceptions and current clinical practices. Responses were measured using quantitative methods, and agreeability and frequency responses were measured using a 5-point Likert scale.

RESULTS

Twenty-three of the 31 eligible providers (74.2%) completed the survey. Providers acknowledge that patients need weight management discussions and they feel comfortable and are willing to have these discussions. While physical activity recommendations were consistent among providers, they did not reflect the complete physical activity recommendations for Americans. Consistency in dietary recommendations was lacking. Although providers make recommendations for physical activity and/or diet at least sometimes, they rarely utilize other methods of weight management as outlined in the ACOG recommendations, such as referrals to other providers, programmes or medications.

CONCLUSIONS

Areas for improvement in weight management practices include frequency of counselling, consistency in dietary counselling and frequency of utilization of weight loss medications and referrals to ancillary services. These results can be used to aid the development of methods for targeting these deficiencies.

Stereotype threat and health disparities: what medical educators and future physicians need to know

Patients' experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual's group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics.

The search for good compliance: economic aspects of a conveyed combination pharmaco-therapy, exemplified by an osteoporosis therapy

The discussion of adequate compliance in health care often refers to a lack of information between patients and physicians. In our setting, we show that contract arrangements as well as the distribution of information are important for an adequate alignment of the interest of patients and physicians. The analysis emphasises the benefit of organised pharmaco-therapy enhancing the concomitant compliance. Therefore, the results can work as a proxy for the need of good economic-based approaches discussing compliance in chronic diseases.

Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health?

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers' contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers' behaviors may contribute to these disparities.

Prevention in adulthood: forging a doctor-patient partnership

In this ever-changing health care system, Americans still retain confidence in their individual physicians [11]. This confidence represents an impressive fact when placed in the context of today's threats to the physician-patient relationship. In this chapter, we have explored these threats, principle among which are the appearance of the hospitalist, the information and technology revolution and the preeminence of managed care. We have further attempted to describe particular physician characteristics that may affect the quality of the physician-patient relationship. Individual physician awareness and characteristics seem to form the cornerstone for the quality of the relationship. We certainly believe in and stress the importance of shared mutual obligations in the good physician-patient relationship. Descriptors such as patients' trust and physicians' empathy enable meaningful relationships to be nurtured over time. A key component worthy of the primary care physician's consideration is that of longitudinal, continuity of care. In a study that examined patients' trust in their physicians, nearly three fourths of those surveyed were confident that their physicians would "put (the patient's) needs above all other considerations" [12]. Despite the limitations inherent in the modern American medical environment, it is still possible for physicians to nurture trusting, effective relationships with their patients and ultimately enhance health outcomes.

Physician advice, patient actions, and health-related quality of life in secondary prevention of stroke through diet and exercise

BACKGROUND AND PURPOSE

Healthy diet and exercise are recommended for secondary prevention in stroke patients. We examined the prevalence of persons with stroke who received physician advice for, and engaged in, dietary change and exercise, and we also sought to determine whether engaging in these actions was associated with differences in health-related quality of life (HRQOL).

METHODS

Data are from 51 193 participants in the 1999 Behavioral Risk Factor Surveillance System, a state-based telephone survey. The participants noted whether they were advised to eat fewer high fat/high cholesterol foods and to exercise more and whether they engaged in these activities. HRQOL measures were the reported number of the preceding 30 days when physical health was not good, mental health was not good, usual activities were limited, and both physical and mental health were good (healthy days).

RESULTS

Overall, 2.4% of the participants reported a history of stroke. Sixty-one percent of those who reported a history of stroke had been advised to eat fewer high fat/high cholesterol foods, and 85.4% of those who had received such advice reported a dietary change compared with 56.0% of those who did not receive such advice. Almost 64% of those who reported a stroke had been advised to exercise more, and 76.5% of those who received such advice reported exercising more versus 38.5% of those who did not receive such advice. Persons with stroke who reported exercising had fewer limited activity days and days when physical health was not good and more healthy days than did persons who did not exercise. Dietary actions were not associated with differences in HRQOL.

CONCLUSIONS

Results highlight the importance of provider advice for secondary prevention among persons with stroke.

Research on the provider contribution to race/ethnicity disparities in medical care

OBJECTIVE

Little is known about why black patients and other ethnic/racial minorities are less likely to receive the best treatments independent of clinical appropriateness, payer, and treatment site. Although both provider and patient behavior have been suggested as possible explanatory factors, the potential role of provider behavior has remained largely unexplored. Does provider behavior contribute to systematic inequities? If so, why? The purpose of this paper is to build on existing evidence to provide an integrated, coherent, and sound approach to future research on the provider contribution to race/ethnicity disparities in medical care. First, the existing evidence suggestive of a provider contribution to race/ethnicity variance in medical care is discussed. Second, a proposed causal model, based on a review of the social cognition and provider behavior literature, representing an integrated set of hypothesized mechanisms through which physician behavior may contribute to race/ethnicity disparities in care is presented.

CONCLUSION

There is sufficient evidence for the hypothesis that provider behavior contributes to race/ethnicity disparities in care to warrant further study. Although there is some evidence of support of the hypotheses that both provider beliefs about of patients and provider behavior during encounters are independently influenced by patient race/ethnicity further systematic rigorous study is needed and is proposed as a major immediate research priority. These mechanisms deserve intensive research focus as they may prove to be the most promising targets for interventions intended to ameliorate the provider contribution to disparities in care.