Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics

Med Care. 1999 Aug;37(8):738-47. doi: 10.1097/00005650-199908000-00004.


Objective: This study assesses the effects of competing demands, such as poor health habits or new medical problems, on health-habit counseling during a primary care visit.

Methods: We surveyed a consecutive sample of 1,259 patients visiting primary care clinicians at an academic VA medical center. Before the visit, patients reported their health status, health habits, and sociodemographics; immediately after the visit, patients reported reasons for the visit and whether they had been counseled about specific health habits. We scored visit acuity ranging from visits for unscheduled walk-in care or new medical problems to scheduled visits for check-ups or old problems. We defined counseling "triggers" as clinical indications for counseling about particular health habits (e.g., 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 counseling. Controlling for other independent variables, patients with more triggers 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 acuity.

Conclusions: Physicians set priorities for health-habit counseling during a visit based on patients' health habit problems or triggers; whether the visit is scheduled or walk-in; and whether the patient has new or acute problems. Future research about primary care performance of health habit counseling should account for these patient and visit characteristics, and prevention-oriented health care organizations should ensure access to scheduled "check-up" visits.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • California
  • Cohort Studies
  • Counseling / statistics & numerical data*
  • Habits*
  • Health Behavior*
  • Health Services Needs and Demand / statistics & numerical data*
  • Humans
  • Likelihood Functions
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Odds Ratio
  • Primary Health Care / statistics & numerical data*
  • Surveys and Questionnaires
  • United States
  • United States Department of Veterans Affairs