Factors influencing U.S. physicians' decision to provide behavioral counseling

PrEP prescription in indiana 2017-2022: Implications for clinical practice

The Ending the HIV Epidemic initiative is poised to eradicate HIV through increasing screening and linkage to care. Despite this, the rate of HIV testing remains inadequate, and effective preventive measures like pre-exposure prophylaxis (PrEP) are not adequately prescribed. A retrospective chart review was conducted to include 2017 through July 2022 from a large nonprofit health care system in the Midwest. Inclusion criteria included an HIV-negative diagnosis between 2017 and July 2022. Additional information includes gender, age, race/ethnicity, the primary payment method, the facility where screening occurred, history of PrEP prescription, and the provider who documented sexual health screening. Most patients were female (73%, n = 3366), followed by 27% (n = 1242) who identified as male. The majority identified as white (52.4%, n = 2415), and patients who identified as Black represented 45.3% (n = 2087) of the sample. Of the participants in the sample, n = 3030 (65.8%) did not have a documented sexual health assessment at the time of HIV screening. Black patients were 0.40 times less likely to report a PrEP prescription than their white counterparts. Patients screened by the provider and identified with infectious disease via a sexual mode of transmission demonstrated three times increased odds of being prescribed PrEP. This research highlights the importance of updating medical records systems to capture salient sexual health factors. Ongoing professional development should be made readily available so providers can conduct comprehensive sexual health assessments.

Provider perspectives on nutrition interventions in primary care: the role of organizational structure and community partnerships

BACKGROUND

Poor nutrition remains a significant public health concern that is often managed within primary care settings. Meanwhile, to our knowledge, there have been few studies that evaluate the intent of primary care providers to offer nutrition services, nor what type of exchanges they engage in to ensure those programs can be implemented.

METHODS

Semi-structured interviews were conducted with 16 primary care providers and support staff. Grounded theory analysis was utilized to identify themes and to develop a theoretical model of primary care nutrition program implementation.

RESULTS

Three themes were identified. Patients approached primary care organizations with complex health beliefs, health severity, and barriers to care (theme 1). Providers and support staff responded by providing services that fit into existing organizational constraints, especially constraints related to workflow/time with patient, space and billing (theme 2). Providers see community as a major cue to action among patients but are unsure of the role of primary care (theme 3).

CONCLUSIONS

Provider respondents found that implementing nutrition programs in primary care settings is difficult and that effective interventions for nutrition within health settings are limited without community-based partnerships and programming. Additional research is needed to measure existing community ties and how such ties could improve patient nutrition.

Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners

Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.

Delivering brief physical activity interventions in primary care: a systematic review

BACKGROUND

Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown.

AIM

To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity.

DESIGN AND SETTING

A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results.

METHOD

CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model.

RESULTS

After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice.

CONCLUSION

PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.

Lifestyle Habits and Wellbeing Among Physicians in Pakistan: A Cross-Sectional Study

Introduction Physicians' attitude towards a healthy lifestyle is important as it determines their extent of acceptance of these habits leading to overall well-being. Physicians with healthy lifestyle habits are more confident in advocating the same to their patients and their patients are keener in adopting lifestyle modifications. This study aimed to evaluate the lifestyle habits, wellbeing, and mental health of physicians in Pakistan. Methods A multi-center, cross-sectional survey was conducted with physicians across Pakistan from August to October 2020. A total of 1406 participants were gathered by the non-probability convenient sampling technique. Data were collected physically from the participants. A semi-structured, self-administered questionnaire comprising socio-demographic information, lifestyle habits, mental well-being, and well-being, in general, was filled. Mental wellbeing was assessed using the Warwick Edinburg Mental Wellbeing Scale (WEMWBS) comprising 14-positive items scored on a 1-5 point Likert scale where 1 corresponds to "none of the time" and 5 corresponds to "all of the time." The score ranges from a minimum of 14 to a maximum of 70 points. Higher scores are associated with higher levels of mental wellbeing. Data were stored and analyzed using IBM-SPSS v.23 (IBM Corp., Armonk, NY). Results In this survey, there were 1284 (91.3%) males and 122 (8.7%) females with a mean age of 44.09 ± 11.18 years. More than half (n=768; 53.0%) of the physicians reported their general health as "good," 1045 (73%) were satisfied with their work-life balance, 206 (14%) had seen a physician for their health in the last six months, and 358 (25%) never had a routine medical checkup. When WEMWBS was applied, participants ≤40 years scored significantly higher than the older age group (p<0.01). Male physicians also scored significantly higher on WEMWBS (52.35 ± 8.78) as compared to their female counterparts (p<0.01). WEMWBS scores also varied significantly across various levels of expertise - with consultants scoring the highest (52.67 ± 9.02) and others scoring the lowest (48.63 ± 8.58; p=0.02). Physicians practicing in the public hospitals only (53.05 ± 9.02), scored higher on WEMWBS as compared to those in the private hospitals (51.28 ± 8.12) as well as those practicing in private clinics only (49.57 ± 8.82; p<0.01). Physicians who perceived their health as excellent scored highest on WEMWBS (53.55 ± 9.31), than those who considered their health good (51.68 ± 8.40), poor (50.71 ± 9.27), or fair (48.70 ± 8.15; p<0.01). The correlation analysis showed a significant negative correlation of WEMWBS scores with health in general (2.5% variation) and age (0.92% variation; p<0.01). Conclusion Physicians in our study were mostly satisfied with their general health and work-life balance. Nevertheless, their mental health well-being was not satisfactory, as assessed by WEMWBS. There is a dire need for lifestyle modifications among the medical practitioners who may improve their mental and physical well-being subsequently allowing them to cater to their patients more effectively. It is recommended that physician-patient-specific interventions should be developed to target the health status and mental well-being of a physician and to encourage the physicians especially the fresh medical graduates and young doctors to indulge in healthy activities.

Characteristics of US Adults Who Would Be Recommended for Lifestyle Modification Without Antihypertensive Medication to Manage Blood Pressure

BACKGROUND

The 2017 American College of Cardiology / American Heart Association Guideline for blood pressure (BP) management newly classifies millions of Americans with elevated BP or stage 1 hypertension for recommended lifestyle modification alone (without pharmacotherapy). This study characterized these adults, including their cardiovascular disease risk factors, barriers to lifestyle modification, and healthcare access.

METHODS

This cross-sectional study examined nationally representative National Health and Nutrition Examination Survey data, 2013-2016, on 10,205 US adults aged ≥18, among whom 2,081 had elevated BP or stage 1 hypertension and met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone.

RESULTS

An estimated 22% of US adults (52 million) would be recommended for lifestyle modification alone. Among these, 58% were men, 43% had obesity, 52% had low-quality diet, 95% consumed excess sodium, 43% were physically inactive, and 8% consumed excess alcohol. Many reported attempting lifestyle changes (range: 39%-60%). Those who reported receiving health professional advice to lose weight (adjusted prevalence ratio 1.21, 95% confidence interval 1.06-1.38), reduce sodium intake (2.33, 2.00-2.72), or exercise more (1.60, 1.32-1.95) were significantly more likely to report attempting changes. However, potential barriers to lifestyle modification included 28% of adults reporting disability, asthma, or arthritis. Additionally, 20% had no health insurance and 22% had no healthcare visits in the last year.

CONCLUSIONS

One-fifth of US adults met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone, and many reported attempting behavior change. However, barriers exist such as insurance gaps, limited access to care, and physical impairment.

Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study

Background

Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors.

Methods

We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits.

Results

Among doctors, 31% reported &lt;10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices.

Conclusions

Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients.

Clinical counseling on sun protection and indoor tanning avoidance: A survey of current practices among U.S. health care providers

Clinicians can play a role in skin cancer prevention by counseling their patients on use of sun protection and indoor tanning avoidance. We used data from the 2016 DocStyles, a web-based survey of U.S. primary care providers, to examine skin cancer prevention counseling practices among 1506 providers. In 2018, we conducted logistic regression analyses to examine factors associated with regularly providing counseling. Almost half (48.5%) of all providers reported regularly counseling on sun protection, and 27.4% reported regularly counseling on indoor tanning. Provider characteristics associated with regular counseling included having practiced medicine for at least 16 years (sun protection: adjusted prevalence ratio [aPR] = 1.27, 95% confidence interval [CI] = 1.15, 1.41; indoor tanning: aPR = 1.38, 95% CI = 1.17, 1.63), having treated sunburn in the past year (sun protection: aPR = 1.78, 95% CI = 1.46, 2.17; indoor tanning: aPR = 2.42, 95% CI = 1.73, 3.39), and awareness of U.S. Preventive Services Task Force recommendations (sun protection: aPR = 1.73, 95% CI = 1.51, 2.00; indoor tanning: aPR = 2.70, 95% CI = 2.09, 3.48). Reporting barriers to counseling was associated with a lower likelihood of regularly counseling on sun protection (1-3 barriers: aPR = 0.82, 95% CI = 0.71, 0.94; 4+ barriers: aPR = 0.80, 95% CI = 0.69, 0.93) and indoor tanning (1-3 barriers: aPR = 0.72, 95% CI = 0.57, 0.91; 4+ barriers: aPR = 0.61, 95% CI = 0.47, 0.78). Barriers to counseling included lack of time (58.1%), more urgent health concerns (49.1%), and patient disinterest (46.3%). Although many providers report regularly counseling patients on skin cancer prevention, most report serious barriers to providing such counseling. Additional research could explore strategies to integrate compelling and informative skin cancer prevention counseling into current provider practices.