Docs Should Tackle Patients' Problem Behaviors All at Once: Study

Issues like smoking, bad diets were better overcome that way, researchers say

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WEDNESDAY, June 13, 2007 (HealthDay News) -- Patients often come to doctors with many behavioral or dietary problems that exacerbate their health woes. Now, a new study finds it may be more effective for physicians to tackle these factors all at once instead of one at a time.

The 18-month study, conducted by a team at Baylor College of Medicine in Houston, included 289 black American smokers with hypertension randomly assigned to one of three groups designed to help them do three things: quit smoking, reduce their daily salt intake, and increase their physical activity by at least 10,000 steps per week.

Participants in the first group simultaneously received one in-clinic counseling session on all three behaviors every six months, along with motivational telephone calls for 18 months.

The second "sequential" group followed a similar protocol, but addressed a single, different behavior every six months.

The third group received usual care -- a one-time referral to existing group classes.

The participants were assessed at six, 12 and 18 months, and 230 of them completed the full study.

After 18 months, only 6.5 percent of participants in the simultaneous group, 5.2 percent of those in the sequential group, and 6.5 percent of those in the usual-care group met the study's primary endpoint of changing two or three behaviors.

"However, results for single behavioral goals consistently favored the simultaneous group," the study authors noted.

For example, after six months, 29.6 percent of those in the simultaneous group had reached the sodium intake reduction goal, compared with 16.5 percent in the sequential group and 13.4 percent in the usual-care group.

At 18 months, 20.3 percent of those in the simultaneous group had stopped smoking, compared with 16.9 percent in the sequential group and 10.1 percent in the usual-care group.

"Long-term multiple behavior change is difficult in primary care. This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach," the researchers wrote.

The study was published in the June 11 issue of the journal Archives of Internal Medicine.

More information

The American Academy of Family Physicians explains how common behaviors affect your health.

SOURCE: JAMA/Archives journals, news release, June 11, 2007

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