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

Bruce A. Chernof, Scott E. Sherman, Andrew B. Lanto, Martin L. Lee, Elizabeth M. Yano, Lisa V. Rubenstein

Research output: Contribution to journalArticlepeer-review


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 (eg, 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.

Original languageEnglish (US)
Pages (from-to)738-747
Number of pages10
JournalMedical care
Issue number8
StatePublished - Aug 1999


  • Counseling
  • Doctor-patient communication
  • Health promotion
  • Health surveys
  • Primary care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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