Preventive and hospitalist medicine
What role, if any, should the hospitalist play in preventive medicine?
This topic was discussed by Suneel Dhand, MD, a hospitalist and clinical professor at Tufts University, in a Blog last November.
Dr. Dhand suggested that front-line hospitalists may be missing important opportunities to teach primary prevention and health promotion to their hospitalized patients. They may believe they do not have time for these activities, except for specific diet and lifestyle recommendations that are essential in terms of planning hospital discharges for patients with heart failure.
Hospitalists may also feel that prevention is not their role or one for which they have been trained, Dr. Dhand wrote, and yet hospitalists have a natural captive audience for their patients’ health education.
The illustrations he offers – recommendations to eat more vegetables and exercise more – have almost universal application. Medscape asked Dr. Dhand for other suggestions, including “eating less saturated fat and simple carbohydrates, reducing red meat, increasing fiber intake, quitting smoking, reducing alcohol consumption, and going out at every opportunity.” .
Dr. Dhand emphasized that he was not suggesting a major new time commitment for busy hospitalists, “just a passing statement in the context of other patient contacts, tailored to each patient’s condition,” a- he declared. “There’s a lot of potential here that we’re not fully grasping.”
But he hasn’t received many responses to his article and sees a general lack of enthusiasm for the concept among his peers. More research is needed on prevention education in the hospital, he added, but the real key lies in training current and future hospitalists to emphasize the importance of primary prevention, helping them to see this as a useful activity for their role in the hospital. “Ultimately, it has to come from within,” he said.
The role of the health system in preventive care
More tightly integrated health systems and multispecialty medical groups may find it easier to champion the cause of prevention. “I’ve worked in integrated medical groups where we were more closely linked to the primary care physician,” Dr. Dhand said. An increased emphasis on prevention and health promotion by hospitalists could also contribute to hospitals’ attempts to manage avoidable hospital readmissions.
“There have been studies of things like inpatient alcohol or tobacco cessation counseling,” notes Gregory Maynard, MD, senior vice president of the Center for Improvement and Innovation of Healthcare of the Society of Healthcare Medicine and director of the Center for Innovation and Improvement. Science at the University of California, San Diego. “But I’m not aware of any rigorous studies looking at more general inpatient preventive medicine advice from hospitalists.”
“I think the central idea of Dr. Dhand’s blog, that a few minutes of encouragement and advice from the hospital patient side might be helpful, is well accepted by hospitalists,” added Dr. Maynard. “But it plays out quite variably.”
Vineet Arora, MD, an academic hospitalist at the University of Chicago, studied the hospital as a missed opportunity to do primary care work, such as teaching inhalers for COPD patients or more intensive counseling in smoking cessation.
Other opportunities, she said, include screening hospitalized patients for sleep apnea, given that two in five hospitalized patients are at high risk of developing the condition.
