RESEARCHPatients’ Need for More Counseling on Diet, Exercise, and Smoking Cessation: Results from the National Ambulatory Medical Care Survey
Section snippets
Objective
The objective of this study was to determine the percentage of physicians who reported counseling patients during their office visits on diet/nutrition, exercise, weight reduction, or smoking cessation in the 2002 National Ambulatory Medical Care Survey (NAMCS) and thereby establish whether patients are receiving adequate counseling from physicians.
Methods
We examined counseling services provided to patients in the ambulatory care setting using the 2002 NAMCS.14 The National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) administer this annual survey, which captures data on health care services provided by nonfederally employed office-based physicians. NAMCS uses a multistage probability sampling procedure, which incorporates the physician's geographic location, physician selection, and patient
Results
In visits for patients with type 2 diabetes, hyperlipidemia, hypertension, or obesity, the mean age (± SD) was 61.4 ± years. The majority of patients were white (82.4%) women (57.8%) with nonprivate insurance (50.1%).
More than one half of all visits for patients with type 2 diabetes, hyperlipidemia, or hypertension did not receive any type of counseling, and of the three counseling categories, patients were more likely to receive counseling classified as diet/nutrition or exercise than as weight
Discussion
Except for visits for those patients diagnosed as obese, during the majority of visits for patients with type 2 diabetes, hyperlipidemia, or hypertension, patients did not receive counseling on diet or exercise from their physicians. Even during visits for patients receiving weight loss drugs, 20% did not receive any type of diet or exercise counseling. Older patients, nonwhite patients, men, and patients with nonprivate insurance were less likely to be counseled by physicians. In addition, in
Limitations
This study is limited by the lack of body mass index (BMI) information on the survey form. Therefore, we could not ascertain whether patients were overweight or obese. However, for the specific diseases we examined, obesity is known to be a leading factor in their development, and 65% of all adults older than 20 years have a BMI greater than 25 kg/m2. In addition, for these diseases, lifestyle modifications independent of weight loss have been shown to be beneficial.
Another limitation is that
Conclusion
During more than 50% of visits for patients with type 2 diabetes, hyperlipidemia, or hypertension, or who are receiving drugs potentially for these diseases, counseling for diet/nutrition, exercise, or weight reduction was not provided by the physician. Of physicians visits for patients who use tobacco, nearly four fifths did not include any counseling on smoking cessation, even for patients too young to legally purchase tobacco products.
Pharmacists are widely accepted as the most accessible
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Disclosure: The authors declare no conflicts of interest or financial interests in any products or services mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.