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Effectiveness in Disease and Injury Prevention Counseling Practices of Primary-Care Physicians -- North Carolina, 1991

Because 80% of the U.S. population visits a physician each year (1), physicians are an important source for health education. In particular, physicians have unique opportunities to influence and modify health-risk behaviors of their patients. During 1991, the North Carolina Department of Environment, Health, and Natural Resources (DEHNR), the University of North Carolina at Chapel Hill, and CDC conducted a survey of nonmilitary primary-care physicians practicing in North Carolina regarding counseling and referral practices. This report summarizes results of this survey, including estimates of the proportion of primary-care physicians who counsel and/or refer for treatment patients who smoke, abuse drugs or alcohol, or have diet- or nutrition-related problems.

A primary-care physician was defined as a physician specializing in general practice, family practice, internal medicine, or obstetrics and/or gynecology (OB/GYN) who graduated from medical school in 1990 or earlier. A stratified sample of 1200 physicians in the four specialty groups in North Carolina was selected using a national sampling frame; 514 eligible physicians responded. The Council on American Survey Research Organizations' (2) response rate (58.6%) was used to account for unknown eligibility status of nonresponding physicians. Sample weights were adjusted to compensate for substantial differences in response rates. Software for Survey Data Analysis (SUDAAN) (3) was used to provide weighted estimates for the population of primary-care physicians practicing in North Carolina.

Physicians were asked about their attitudes and beliefs regarding counseling. In addition, physicians were asked what percentage of their patients who they believe smoke, abuse drugs or alcohol, or have diet/nutrition problems they counseled and/or referred for treatment. Physicians who reported counseling and/or referring more than 80% of these patients were classified as "routinely counseling and/or referring at-risk patients."

Of the 514 respondents, 90% were white, 87% were male, and 72% were board certified. The mean age of respondents was 46.8 years (range: 26-87 years) and the mean percentage of professional time spent providing patient care was 86% (range: 10%-100%).

Most (96%) physicians agreed that primary-care physicians should assist asymptomatic patients in reducing behavioral risk factors. Routine counseling and/or referral was reported by 51.3% of physicians for patients who smoke, 50.0% for patients who abuse drugs, 34.5% for patients who abuse alcohol, and 18.9% for patients with diet/nutrition problems (Table 1).

White physicians, female physicians, and physicians aged 26-44 years generally reported higher counseling and/or referral rates than other subgroups. However, patterns did not vary consistently by location of medical school, board certification, or practice setting. The percentage of physicians specializing in internal medicine who routinely provided smoking counseling was substantially lower than that for physicians in general practice, family practice, or OB/GYN (Figure 1).

Reported by: J Dever, W Kalsbeek, PhD, L Sanders, Univ of North Carolina at Chapel Hill; M Bowling, PhD, R Holstun, E Lengerich, VMD, G Stoodt, MD, North Carolina Dept of Health, Environment, and Natural Resources. Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Behavioral risk factors such as smoking, alcohol abuse, drug abuse, and poor eating habits are major contributors to chronic disease morbidity and mortality. Health education, especially when offered through primary-care physicians, can be an effective tool in reducing the prevalence of these risk factors.

In North Carolina, the percentage of physicians who reported providing counseling/referral services for specific behaviors (18.9%-51.3%) is substantially lower than the percentage (75%) targeted by the national health objectives for the year 2000 (1). The findings in North Carolina may be overestimated because of self-reported data and a response rate of 58.6%. However, individual and combined response rates were comparable to response rates in previous self-reported physician surveys (34%-78%) (4).

Partners-in-Prevention, a cooperative initiative between North Carolina medical societies and DEHNR, will use the findings from this study to identify and help address obstacles to providing health education through primary-care physicians. In addition, this survey will be modified and used periodically to monitor preventive practices, to assess barriers to providing preventive services, and to identify effective methods of increasing the use of health education and preventive services by primary-care physicians.


  1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  2. CASRO Task Force on Completion Rates. On the definition of response rates -- special report. New York: Council on American Survey Research Organizations, 1982.

  3. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 (Software documentation). Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

  4. Greenwald HP, Hart LG. Issues in survey data on medical practice: some empirical comparisons. Public Health Rep 1986;101:540-6.

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