Race, gender, and lifestyle discussions in geriatric primary care medical visits

Abstract

Increasingly, healthcare providers are required to spend more time and effort aimed at prevention and lifestyle modification. Many argue that providers are in a unique position to provide information for effective lifestyle and behavior change. Yet, relatively little is known about how in- terpersonal provider and patient characteristics, such as race and gender, affect discussions of lifestyle choices about public health issues. To understand better how patient and physician characteristics influence discussions of lifestyle behaviors, we conducted a prospective, cohort study of interactions between primary care physicians and their geriatric patients. We videotaped 381 elderly patient visits with 35 primary care physicians. We coded the encounters to indicate whether the patient and physician discussed lifestyle issues around nutrition, physical activity, and smoking. The independent variables were patient and physician race, gender, and concordant status. Discussions about nutrition were the most common lifestyle topic (47.8%), followed by physical activity (40.3%) and smoking (14.2%). Multivariate analysis indicate white patients are significantly less likely to have discussions with their physicians about nutrition (OR = 0.32, p = 0.02) and same gender encounters are also less likely to discuss diet/nutrition (OR = 0.59, p = 0.04). There were no significant differences for discussions about physical activity or smoking. Previous research has shown that differences persist in the quality of care and certain outcomes. Our results suggest these differrences are not exclusively the result of differences in the prevalence of lifestyle discussions based on patient and physician race or gender.