The Role of Hospitalists in Preventive Medicine

Larry Beresford

Disclosures

February 05, 2015

Preventive Medicine and the Hospitalist

What role, if any, should the hospitalist play in preventive medicine?

This topic was tackled by Suneel Dhand, MD, a hospitalist and clinical professor at Tufts University, in a blog last November.

Dr Dhand suggested that frontline hospitalists may be missing important opportunities to teach primary prevention and health promotion to their hospitalized patients. They may believe that they don't have time for these activities—except for specific dietary and lifestyle recommendations that are essential in terms of planning hospital discharges for heart failure patients.

Hospitalists may also feel that prevention is not their role or one that they have been trained for, Dr Dhand wrote, and yet hospitalists have a natural captive audience for health education with their patients.

The illustrations he offered—recommendations to eat more vegetables and to get more exercise—have almost universal application. Medscape asked Dr Dhand for other suggestions, which include "eating less saturated fat and simple carbohydrates, cutting down on red meat, increasing fiber intake, smoking cessation, cutting back on alcohol, and getting outdoors at every opportunity."

Dr Dhand emphasized that he's not suggesting a major new time commitment for busy hospitalists, "just a passing statement in the context of other contacts with patients, tailored to each patient's condition," he said. "There's a lot of potential here that we don't fully grasp."

But he hasn't received much response to his piece and sees a general lack of enthusiasm for the concept among 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 view this as a worthwhile 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 might find it easier to take up the cause of prevention. "I have worked in integrated medical groups where we were more closely aligned with the primary care physician," Dr Dhand said. A greater emphasis on prevention and health promotion by hospitalists could also contribute to hospitals' attempts to manage avoidable hospital readmissions.

"There have been studies on things like alcohol or tobacco cessation counseling in the inpatient setting," notes Gregory Maynard, MD, senior vice president of the Society of Healthcare Medicine's Center for Healthcare Improvement and Innovation, and director of the Center for Innovation and Improvement Science at the University of California-San Diego. "But I don't know of any studies with rigor looking at more general preventive medicine counseling in the inpatient setting by hospitalists."

"I think the central idea from Dr Dhand's blog—that a few minutes of encouragement and counseling on the inpatient side could be valuable—is well accepted by hospitalists," Dr Maynard added. "But it is performed quite variably."

Vineet Arora, MD, an academic hospitalist at the University of Chicago, has studied the hospital as a missed opportunity to do primary care work, such as inhaler teaching for COPD patients or more intensive smoking cessation counseling.

Other opportunities, she said, include screening hospitalized patients for sleep apnea, given that two out of every five hospitalized patients are at high risk for this condition.

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