Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be “tailored” for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.

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Background
After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. Methods: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. Results: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P＜0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. Conclusion: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician. (J Korean Acad Fam Med 2008;29:325-329)

Background
: The purpose of this survey was to assess knowledge of the public on family medicine through the analysis of medical counseling by PC communication and compare them with that of internal medicine.

Methods : This survey analyzed the content of medical counseling by PC communication according to ICPC from Oct. 1996 to Jun. 1998. The survey was done by means of E-mail in Nownuri eyes and the selected medical departments were those of family medicine and internal medicine in Pusan National University Hospital.

Results : The total number of questions was 342, including 181 in the department of family medicine and 161 in internal medicine. In the analysis of medical counseling according to ICPC, there was a significant difference between family medicine and internal medicine in the reasons for questions by components(P<0.001). In family medicine, the reasons were symptoms, complaints(66.9%), diagnoses, diseases(18.8%), treatment, procedure, medication(17.2%), and diagnostic, screening, prevention(5.5%). In internal medicine, the reasons for questions were symptoms, complaints(64.6%), diagnoses, diseases(21.1%), treatment, procedure, medication(9.3%), and test results(4.3%).
There was a significant difference between family medicine and internal medicine in the questions by chapters(P<0.05). In family medicine, the questions about digestive system were 28 cases(15.5%), neurological system were 26 cases(14.4%), musculoskeletal system were 25 cases(13.8%), and unspecified were 25 cases(13.8%). In internal medicine, the questions about digestive system were 76 cases(47.2%), circulatory system were 21 cases(13.0%), and respiratory system were 15 cases(9.3%). The most common symptom was headache in family medicine and generalized abdominal pain in internal medicine.

Conclusion : There were significant differences in the age distribution, the reasons for questions, and the contents of questions between family medicine and internal medicine.

Background
: Appropriate referral without failure, one of important health care services provided by primary care physicians, is very helpful not only to patients but also to the referring physicians. This study was performed to observe the rate of referral failure and to evaluate the factors related to referral failure.

Methods : from June 10 to October 31, 1997, all referrals made in the department of family practice in the Samsung Medical Center were studied. Structured questionnaires inquiring of referral initiator, physician's view of clinical severity and referral necessity, and the reason for referral were completed by referring physician whenever each referral was made. On the 60th day after referrals were initiated, medical records of the referred patients were reviewed to obtain the information on the demographic characteristics of the patients referred, the contents of referral, and the patient's attendance the specialist clinic after referral. Each referral was audited by five family physicians working at the Somsung Medical Center to examine the appropriateness of the time when the referral was initiated. The patients who did not attend at specialist clinic to which they were referred to were telephoned to ask about the reasons for the referral failure. Chi-square test and multiple logistic regression analysis used to evaluate the factors related to referral failure.

Results : During the study period, total of 477 referrals were made among 9.384 encounters and the referral rate was 5.08%. Fifty-eight patients failed to complete the referral process within predetermined period and the rate of referral failure was 12.16%. The risk of referrals failure was significantly low in cases whose referral time was assessed as appropriate(odds ratio=0.53). Female was a significant increasing the risk of referral failure(odds ratio=1.91). Being too busy(24.14%) was the most common reason for referral failure. Other reasons included improvement or resolution of symptoms(12.06%), information on the referral was not give(6.9%) and too great a distance the between hospital and the patients home(6.9%). Four patients forgot to attend the hospital.

Conclusion : Considerable proportion of patients being referred did not complete the referral process. Timely referral and sufficient discussion between physician and patient being referred seems to be necessary. to prevent referral failure.