The Prevalence of Physicians Who Emphasize Wellness and Provide Educational Materials for their Patients

Brief communication 175 THE PREVALENCE OF PHYSICIANS WHO EMPHASIZE WELLNESS AND PROVIDE EDUCATIONAL MATERIALS FOR THEIR PATIENTS In recent years, the emphasis on health promotion and disease prevention within the medical community has grown. Chronic diseases afflict nearly 100 million Americans, and their estimated direct health care costs of $425 billion account for three-fourths of our national health expenditures, with an additional $234 billion spent on indirect costs.1 Health promotion and disease prevention represent efforts to control the burden of suffering and the staggering costs associated with chronic diseases. Such measures have the objectives of motivating health behavior changes and encouraging patients to take greater initiative in their health care. Thus far, primary care physicians have been major providers of health promotion and disease prevention services.2 However, the growth of managed health care, and its potential for altering physician-patient dynamics, has raised questions regarding the ability of physicians to adequately deliver health promotion and disease prevention services. Primary care physicians report that managed care has placed various constraints on their practices while reducing time spent with patients.3 Physicians may also differentially counsel patients based on sociodemographic factors. For example, age, education , and income are all positively associated with receiving counseling on exercise from physicians.4 In addition, because physicians may not provide disease prevention services as often as recommended by guidelines,5 there has been a call for improvement in performance, in such areas as smoking6 and cardiovascular disease prevention.7 Relatively little is known about the patient's perspective on their physician 's efforts in providing health promotion and disease prevention services. The purpose of this study was to use data acquired from a recent national survey of Americans to measure the prevalence of physicians providing services relevant to health promotion and disease prevention, as well as to identify those patient factors associated with having such a physician. Method The first Osteopathic Survey of Health Care in America (OSTEOSURV-I) was approved by the institutional review board of the University of North Received August 2,2001; revised April 10,2002; accepted July 3,2002. Journal of Health Care for the Poor and Underserved · Vol. 14, No. 2 · 2003 DOI: 10.1177/1049208903251507 176 Physicians Emphasizing Wellness Texas Health Science Center at Fort Worth. The survey was designed to address issues related to ambulatory health care in the United States; its methodology has been described in detail elsewhere.8 Random digit dialing was used to generate a household sample of U.S. English-speaking residents 18 years of age or older in September and October 1998. Adolescents were not included in the study. A total of 1,106 respondents were surveyed in order to estimate population parameters with a sampling error of ± 3.0 percent. The survey included 139 items concerning ambulatory health care and was designed to be completed in 20 to 25 minutes. The two main outcomes in the present study were assessed using the following statements: "My health care provider emphasizes wellness, including diet and exercise," and "My health care provider gives me educational materials about my health." These statements were followed by the following Likert-type scale responses: strongly agree, agree, neutral , disagree, and strongly disagree. Strongly agree and agree responses were taken to indicate that the physician behavior occurred, whereas neutral, disagree , and strongly disagree indicated that the behavior did not occur. The independent variables included age (representing young adults, middle-aged adults, and older adults), gender, race/ethnicity, education, annual household income, health insurance coverage, and general health perceptions as measured by the Medical Outcomes Study Short Form (SF)-36.9 The Medical Outcomes Study SF-36 has been shown to be valid and reliable and is considered a generic measure because it assesses health concepts that represent basic human values that are relevant to functional status and well-being, regardless of age, disease status, and treatment modality.9 Descriptive statistics were used to summarize the survey results. Multiple logistic regression was then used to compute odds ratios (ORs) and 95 percent confidence intervals (CIs) for each of two main outcomes using the seven independent variables to adjust for potential confounding. The SYSTAT 7.0 for Windows software (Chicago...