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Medical system pays little attention to behavior counseling

WASHINGTON, D.C. -- Despite solid evidence that fairly simple and inexpensive changes in behavior can help Americans get healthier, the translation of that research into practice by the medical system remains haphazard, according to a survey of doctors, HMOs and public health leaders.

The study, issued by the Center for the Advancement of Health, suggests that the solution is to incorporate behavior counseling into the routine office visit.

About half of American adults are living with chronic, but manageable, health conditions, and they visit a doctor an average of 3.1 times a year, according to the Center. More than half of all premature deaths are preventable by modest changes in behavior.

"There is abundant evidence that when health care professionals converse briefly with their patients about risk reduction, illness management and pharmacy use, there is a likelihood that those patients will do better; they are more likely to attempt and succeed at changing poor health habits, more likely to participate in screening, less likely to use unneeded health care services over time, more likely to take the right medicines the right way and better able to engage in work and play," the report concludes.

"Systematically increasing counseling about prevention, adherence and illness management as part of routine medical care has significant potential to improve the health of individuals and the public," it continues.

The Center's Executive Director, Jessie C. Gruman, Ph.D., explains, "Advice from doctors and nurses carries a lot of weight with most people, and the impact of that advice increases when the professional is chosen by the individual and the advice is personal."

The study, supported by the Robert Wood Johnson Foundation, examined the roles of physician training, of health system impediments to behavior counseling and of patient involvement, among other factors. The findings result from interviews with 41 physicians or other medical practitioners, 45 executives of successful prevention programs and 55 leaders of federal, voluntary, medical professional and research organizations.

"Overall, the interviews leave a strong impression that the process by which scientific research is translated into medical care to improve health outcomes takes place in a somewhat haphazard, disorganized fashion," the report concludes.

"No, this is not brain surgery," Gruman says, "but it takes relatively little time or money for a doctor's office to put pink reminder stickers on patients' charts or to send a computerized letter prompting patients to schedule a mammography or a flu shot."

"Now that the federal research establishment is doubling, and a prescription drug benefit for seniors may mean more people using medication, there is no better time to emphasize the basics -- common-sense adherence to sound practices by both patients and their doctors," Gruman says. "Counseling as a routine part of medical care is a case where the translation of research to practice has not taken place effectively, meaning we are not realizing the full benefit of our investment in health research."

The Center for the Advancement of Health is an independent nonprofit organization funded by foundations to promote greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness.

For copies of the report, "Integration of Health Behavior Counseling in Routine Medical Care," go to www.cfah.org or E-mail press@cfah.org

Posted by the Center for the Advancement of Health <http://www.cfah.org>. For more research news and information, go to our special section devoted to health and behavior in the “Peer-Reviewed Journals” area of Eurekalert!, http://www.eurekalert.org/restricted/reporters/journals/cfah/. For information about the Center, call Ira Allen, iallen@cfah.org 202-387-2829.

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