RESEARCH
Patients’ Need for More Counseling on Diet, Exercise, and Smoking Cessation: Results from the National Ambulatory Medical Care Survey

https://doi.org/10.1331/154434506777069516Get rights and content

ABSTRACT

Objective

To determine the percentage of physicians who reported counseling patients on diet/nutrition, exercise, weight reduction, or smoking cessation during their office visits when responding to the 2002 National Ambulatory Medical Care Survey (NAMCS). We sought to establish whether patients are receiving adequate counseling from physicians on the basis of this nationwide survey.

Design

Retrospective database analysis.

Setting

United States.

Participants

Data included 184,668,007 physician visits for patients diagnosed with type 2 diabetes, hyperlipidemia, hypertension, or obesity; 140,362,102 physician visits for patients in which insulin/oral antidiabetics, antihyperlipidemia drugs, angiotensin-converting enzyme inhibitors, thiazide diuretics, or weight loss drugs were prescribed; and 82,317,640 physician visits for patients who smoked or used tobacco.

Interventions

Not applicable.

Main Outcomes Measures

Frequency of responses for counseling/education/therapy about diet/nutrition, exercise, weight reduction, and tobacco use/exposure.

Results

For patients with type 2 diabetes, hyperlipidemia, or hypertension, or patients receiving a drug in one of the drug classes that may indicate the presence of these diseases, patients did not receive any type of diet or exercise counseling during more than one half of all visits. Visits by patients who were diagnosed as obese were most likely to receive any type of counseling (80.2%). Of visits for patients who used tobacco, 78.6% did not include any counseling about smoking cessation.

Conclusion

Patients are insufficiently counseled and educated about the need for lifestyle changes that can affect their risks for common chronic diseases. As accessible and ideally positioned health care providers, pharmacists could potentially affect the rising epidemic of obesity and other lifestyle-related diseases by filling this void.

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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  • Cited by (0)

    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.

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