Study Setting

A survey was administered to Emory University Internal Medicine residents and attending physicians who worked in the medicine clinics at Grady Memorial Hospital, a 1,000-bed, inner-city, indigent care teaching hospital located in Atlanta, GA. The primary care outpatient medical clinics of Grady Memorial Hospital serve a primarily older (mean age 61), female (66%), African-American (93%), low-literate (third-to-fifth-grade reading level), and lower-socioeconomic status (SES) population. A high percentage of patients suffer from hypertension (78%), obesity (45%), high cholesterol (38%), and diabetes (26%). Patients also engage in many high risk behaviors for CVD, including smoking (23%), and sedentary lifestyles (39%).

Physician Subjects

The survey was administered to 71 internal medicine house officers and 17 attending physicians from the Emory University residency-training program. Sixty-seven residents and 15 attending physicians completed the survey for an overall response rate of 93.2%. Table 1 shows the demographic characteristics of attending physicians and residents. Fifty-eight percent of the residents and 47% of the attending physicians were male. The overwhelming majority were white and graduates of U.S. medical schools.
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Table 1. Physician Demographics

Survey Design

Physicians were asked to answer hypothetical patient care questions regarding healthcare services provided to patients seen in the medical clinics of the hospital. The survey instrument was 75 questions in length and based on a similar questionnaire developed by Gemson, et al., with some additional modifications. Variables analyzed included physician demographics, counseling practices when seeing new patients without CVD risk factors, counseling practices when seeing patients with CVD risk factors, counseling attitudes, barriers to providing preventive care, and perceived effectiveness of preventive counseling. When assessing physician counseling practices, participants were offered four categories of response: “always,” “usually,” “occasionally,” or “rarely/never.” When assessing attitudes to counseling, physicians were asked to rate the relative importance of counseling specific risk factors as “very important,” “somewhat important,” “unimportant,” and “don’t know/not sure.” Perceived counseling efficacy on specific risk factors was determined by the responses “very effective,” “moderately effective,” “somewhat effective,” and “minimally effective.” Barriers to counseling were determined by answering “yes” or “no” to the stated the barrier (i.e., “physicians receive little training in prevention”).
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Data Analysis

Survey responses were analyzed using Epilnfo statistical software (version 6.04A) and SAS statistical software (version 8.2). Frequency analysis was performed for categorical variables for total sample, then separately for men vs. women, residents vs. attending physicians. Frequency of ideal behavior (numbers of physicians who reported “always” counseling risk factors, number of physicians reporting at least moderate effectiveness in counseling, etc.) were tabulated. A Chi-squared analysis was conducted to assess sig nificant differences in binomial count data (p<0.05) based on physician training level (i.e., attending faculty vs. resident) or physician gender (male vs. female). All requirements for Chi-squared analysis were met (no cells had less than five expected outcomes, etc.). Chi-squared analysis was also conducted to compare frequency of counseling for exercise, smoking, medication compliance, and diet to assess for significant differences and to compare the frequency of counseling exercise for patients with and without risk factors for CVD.
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