Primary care providers' physical activity counseling and referral practices and barriers for cardiovascular disease prevention

Abstract

The US Preventive Services Task Force (USPSTF) recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. This study determined the proportion of primary care providers (PCPs) who discussed physical activity with most of their at-risk patients and referred them to intensive behavioral counseling, and reported barriers to counseling. Our analyses used data from DocStyles 2015, a Web-based panel survey of 1251 PCPs. Overall, 58.6% of PCPs discussed physical activity with most of their at-risk patients. Among these PCPs, the prevalence of components offered ranged from 98.5% encouraging increased physical activity to 13.9% referring to intensive behavioral counseling. Overall, only 8.1% both discussed physical activity with most at-risk patients and referred to intensive behavioral counseling. Barriers related to PCPs' attitudes and beliefs about counseling (e.g., counseling is not effective) were significantly associated with both discussing physical activity with most at-risk patients and referring them to intensive behavioral counseling (adjusted odds ratio, 1.92; 95% confidence interval, 1.15-3.20). System-level barriers (e.g., referral services not available) were not. Just over half of PCPs discussed physical activity with most of their at-risk patients, and few both discussed physical activity and referred patients to intensive behavioral counseling. Overcoming barriers related to attitudes and beliefs about physical activity counseling could help improve low levels of counseling and referrals to intensive behavioral counseling for CVD prevention.

Keywords: Cardiovascular disease; Counseling; Physical activity; Primary health care.

Fig. 1

Components of physical activity counseling by percentage of at-risk^a patients counseled (N =1043)^b,c, DocStyles, 2015. ^a Patients at increased risk for CVD defined as those who are overweight or obese and have hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome. ^b Excludes primary care providers (PCPs) who selected “None”(n = 2) in response to the question, “With how many of your at risk patients do you discuss physical activity?” ^c Error bars represent 95% confidence intervals.