Direct observation of health-habit counseling of adolescents.

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Abstract
Objectives To determine the rate of health-habit counseling of adolescents seeing community family physicians and to identify the factors associated with the delivery of recommended preventive counseling services. Design Cross-sectional multimethod study emphasizing direct observation of patient visits. Setting Community family practices in northeast Ohio. Patients or Other Participants Adolescents (n=445) aged 11 to 21 years who were being seen for outpatient visits to community family physicians (n=119) during 2 days of observation by trained research nurses. Main Outcome Measure Direct observation of the delivery of clinical preventive counseling services recommended by theGuidelines for Adolescent Preventive Services. Results During the 445 visits made by adolescents, the most frequently delivered counseling service was exercise advice (13%). At least 1 health-habit counseling service was delivered during 38% of visits. In multivariable analyses, older patient age was strongly associated with increased service delivery. Visits for well care, longer visits, and new patient visits were also associated with the provision of counseling. Visits including preventive counseling services were on average 2.5 minutes longer than visits without preventive counseling. Conclusions The rates of delivery of preventive counseling services in clinical practice were low, raising concern about the feasibility of current recommendations. The practical implementation of prevention guidelines may require a greater use of well-care visits and longer patient visits than are currently used in community family practice.