Wednesday, August 17, 2016
When Physicians Counsel About Stress
The prevalence of stress in primary care is high; 60% to 80% of visits may have a stress-related component. Over the past 5 years, 44% of Americans have reported an increase in psychological stress. Stress is associated with more office visits and disease, but little is known about stress management counseling in primary care. Our study objective was to examine the rates of stress management counseling by US primary care physicians and to identify associated factors.
From 2006 through 2009, 1020 of 33 045 office visits (3%) included stress management counseling by primary care physicians. Stress management counseling was the least common type of counseling, compared with counseling about nutrition (16.8%), physical activity (12.3%), weight reduction (6.3%), and tobacco cessation (3.7%).
Adjusted multivariable analyses identified factors independently associated with physician counseling about stress (Table). Older patients (age ≥65 years) were 39% less likely to be counseled, while patients living in the Northeast were 63% more likely to be counseled. Counseling was 43% more likely for patients being seen for a chronic problem flare-up. Counseling increased with the number of chronic conditions. Physicians were more likely to counsel patients with a depressive disorder. Finally, counseling was associated with longer visits.
The low rate of counseling we found is not unique to counseling about stress, since rates of physician counseling are suboptimal across most therapeutic lifestyle interventions. Physicians may recognize the need for providing counseling, but the low rate points to broader delivery issues in primary care. In acknowledgment of the already overburdened primary care physician, our findings highlight the importance of restructuring primary care delivery and payment to emphasize and support a team-based approach. Through such innovations, these emerging models may better incorporate mental health services into clinical care and shift counseling practices to earlier in the disease course, thereby facilitating comanagement of psychosocial stress and disease and potentially improving health outcomes.