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Behavioral Health

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More patients at risk for cardiovascular disease should receive counseling about diet and exercise during outpatient visits

A growing number of Americans have conditions such as high cholesterol, high blood pressure, diabetes, and obesity that increase their risk for heart attack and stroke. Despite national recommendations to counsel such patients about diet and exercise to reduce their risk, counseling remains suboptimal, according to a recent study by researchers at Stanford University. The study was supported by the Agency for Healthcare Research and Quality (HS11313).

The study found that throughout the 1990s, clinicians provided diet counseling in less than 45 percent of office visits and physical activity counseling in 30 percent or fewer visits by adults with conditions that increase their risk of cardiovascular disease. Patients with fewer cardiovascular risk factors, those who were 75 years of age or older, and those seen by generalists were even less likely to be counseled about diet and exercise to reduce their risks. These rates suggest a practice pattern that under-appreciates the importance of lifestyle change in prevention, note the researchers. For the study, they analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey on counseling practices in private physician offices and hospital outpatient departments during the period 1992-2000.

Visits that included counseling increased significantly from 33 percent in 1996 to 45 percent in 1997. Visits to internists and cardiologists were more likely to include diet counseling than were visits to general and family practitioners. Similarly, physical activity counseling was more likely during visits to cardiologists than during visits to general and family practitioners. Obese patients and those with hyperlipidemia were much more likely than other patients to be counseled about diet and physical activity. Yet, a positive diagnosis of coronary heart disease was not associated with any discernible effect on the likelihood of either type of counseling.

See "Diet and physical activity counseling during ambulatory care visits in the United States," by Jun Ma, M.D., Ph.D., R.D., Guido G. Urizar Jr., Ph.D., Tseday Alehegn, M.A., and Randall S. Stafford, M.D., Ph.D., in the October 2004 Preventive Medicine 39, pp. 815-822.

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