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Which patients receive on diet and exercise?

Do certain characteristics affect whether they receive such advice?

Beverley Lawson, MSc
Senior Research Associate in the Primary Care Research Unit of the Department of Family Medicine at Dalhousie University

Fred Burge, MD FCFP MSc
Family physician and Research Director in the Department of Family Medicine at Dalhousie University in Halifax, NS

Correspondence to: Dr Fred Burge, Dalhousie University, Department of Family Medicine, Abbie J. Lane Bldg, 8th Floor, 5909 Veterans Memorial Lane, Halifax, NS B3H 2E2; telephone 902 473–4740; fax 902 473–4760; e-mailfred.burge{at}dal.ca

OBJECTIVE To examine whether patients’ characteristics, familiarity with the clinic, or perspectives on the quality of their care predict whether they receive advice from physicians regarding diet and exercise.

DESIGN Secondary data analysis of responses to the Primary Care Practice Survey.

SETTING Capital District Health Authority in Nova Scotia.

PARTICIPANTS Residents of the Capital District Health Authority 18 years old and older (N = 1562).

MAIN OUTCOME MEASURES Percentage of patients who reported frequently receiving advice from their family physicians regarding diet and exercise.

RESULTS Almost 38% of respondents reported frequently receiving advice from their physicians on diet. Those more likely to receive advice on diet were male (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.2 to 2.1), were 35 to 54 years old (compared with those aged 18to 34) (AOR 1.5, 95% CI 1.1 to 2.2), had more chronic illnesses (AOR 1.3, 95% CI 1.2 to 1.6), had good relationships with their health care providers (AOR 2.3, 95% CI 1.8 to 3.1), or reported higher scores on an enablement scale (AOR 2.2, 95% CI 1.6 to 3.1). Respondents who reported their health status as excellent were less likely toreceive advice on diet (AOR 0.5, 95% CI 0.3 to 0.9). About 42% of respondents reported frequently receiving advice on exercise. Men (AOR 1.7, 95% CI 1.3 to 2.2), those older than 35 years (AOR 1.7, 95% CI 1.2 to 2.4 for those aged 35 to 54; AOR 1.6, 95% CI 1.1 to 2.3 for those 55 and older), those rating their health as good (AOR 1.6, 95% CI 1.1 to 2.4), those with more chronic illnesses (AOR 1.3, 95% CI 1.1 to 1.5), and those reporting higher scores on communication (AOR 3.2, 95% CI 2.3 to 4.4) and enablement (AOR 1.8, 95% CI 1.3 to 2.4) scales were more likely to receive advice on exercise.

CONCLUSION Strategies to increase the number of patients who receive advice on diet and exercise would likely include enhancing communication between patients andtheir physicians, improving relationships between patients and their physicians, and improving physicians’ ability to help their patients feel enabled to act on advice and cope with their illnesses. Physicians should be aware of their counseling practices and consider discussing healthy behaviour with patients with no obvious risk factors. This would be practising true primary prevention.