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PREVENTION

Patient Counseling

Patient education and counseling requires time.  It involves gathering detailed information on factors affecting the patient which will in turn affect the patient’s health.  Gathering and reviewing the patient’s medical history, the patient’s family’s medical history, lifestyle and behaviors affecting medical conditions, access to health services and willingness and/or ability to follow through with treatment recommendations are all necessary components of patient care.

Lack of research in the effectiveness of brief, direct counseling in the context of routine health care had been addressed by the USPSTF in the Guide to Clinical Preventive Services p32-33*. It examines information on counseling based on time, duration, setting, and personnel.  For example, it addresses the effectiveness of lengthy, multiple visits with specially trained counselors vs. short direct counseling in the context of a routine visit.

“The most promising role for prevention in current medical practice may lie in changing the personal health behaviors of patients long before clinical disease develops.” ⁶

According to the CDC, most health burdens are linked to a few harmful behaviors.  Behavioral modification on the part of the patient is crucial to effective primary prevention. 

      Smoking:  contributes to 1 out of every 5 deaths in the U.S. ³⁸

        150,000 deaths annually from cancer

        100,000 deaths annually from coronary artery disease

        23,000 deaths annually from cerebrovascular disease

        85,000 deaths annually from pulmonary disease such as chronic obstructive pulmonary disease and pneumonia

      Unsafe driving practice - lack of safety belt use and driving while intoxicated: ³⁹

        Accounted for 41,000 deaths in 1992

      Physical Inactivity and dietary factors: ^{40 - 43}

        Coronary atherosclerosis

        Cancer

        Diabetes

        Osteoporosis

        Hypertension

      High risk sexual practices: ^{44, 45}

        Unintended pregnancies

        STD’s and HIV/AIDS

Tobacco, alcohol, elicit drug use, diet and activity patterns, motor vehicles, high risk sexual behavior were responsible for nearly half of all deaths in 1990. ⁴⁶

      Interventions geared toward personal health practices are likely to lead to substantial reductions in the incidence and severity of morbidity and mortality

      Primary prevention services that address the leading health indicators will improve overall health to a greater extent than secondary preventive measures such as screening for early disease

      Patients must begin to assume a larger role in maintaining their own health

      The clinician and the patient must share the decision making

 

 

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