Is Your Doctor Giving You Sufficient Advice?

• Position: Disease prevention - Brief Article

Despite assertions that managed care and health maintenance organizations (HMOs)are concerned about disease prevention and health promotion, they rarely give patients the advice they need to modify risky behaviors. A chief reason may be because many such plans do not ensure continuity of care--"a regular doctor"--to foster the patient-physician relationship. Consequently, physicians may be less likely to give important advice for prevention.

The Saint Louis (Mo.) University Prevention Research Center studied 3,024 adults 18 years of age and older in 12 counties in southeast Missouri. Those people living in rural areas often are medically underserved, suffer from high rates of cardiovascular disease, have low education and income levels, and engage in risky health behaviors.

Prevention has been identified by health policymakers, researchers, and practitioners as a means not only to improve health, but to control expenditures in managed care. The study examined the prevalence of physician advice for four preventive health behaviors for cardiovascular disease: increasing physical activity, eating more fruits and vegetables, stopping smoking, and losing weight.

Daniel Gentry, assistant professor, Department of Health Administration, found that respondents with a regular source of care were twice as likely as others to report physician advice in all four preventive health areas. "Our findings provide further evidence that individuals who see their own physician on a regular basis may receive better care. Enduring relationships, leading to greater knowledge of patient history and more open communication, may provide an atmosphere in which physicians are more likely to counsel and advise."

Managed care plays a part in the likelihood of patients having a regular doctor. "Getting good health care has always been about issues of access," he maintains, "which used to mean having insurance or being able to pay out of pocket. But now, as managed care increases its penetration in the marketplace, even those with good health insurance are not assured of seeing the same doctor each visit or having unimpeded access to a doctor."

Ninety-seven percent of physicians feel that it is their responsibility to give advice in order to modify patient behavior to reduce risk factors...