Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS F-77, Atlanta, GA 30341, USA.
Emory University, Laney Graduate School, Nutrition and Health Sciences Doctoral Program, Woodruff Memorial Research Building, 101 Woodruff Circle NE, Room 1337, Atlanta, GA 30322, USA.
Prev Med. 2018 Mar;108:115-122. doi: 10.1016/j.ypmed.2017.12.030. Epub 2017 Dec 27.
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.
美国预防服务工作组（USPSTF）建议为超重或肥胖且有其他心血管疾病（CVD）风险因素的成年人提供或转介给强化行为咨询干预，以促进健康饮食和身体活动，预防 CVD。本研究旨在确定讨论过大多数高风险患者的身体活动并将其转介给强化行为咨询的初级保健提供者（PCP）的比例，并报告咨询的障碍。我们的分析使用了来自 DocStyles 2015 的数据，这是一项针对 1251 名 PCP 的基于网络的小组调查。总体而言，58.6%的 PCP 与大多数高危患者讨论了身体活动。在这些 PCP 中，提供的成分的流行率从鼓励增加身体活动的 98.5%到转介到强化行为咨询的 13.9%不等。总体而言，只有 8.1%的 PCP 既与大多数高危患者讨论了身体活动，又转介了强化行为咨询。与 PCP 对咨询的态度和信念相关的障碍（例如，咨询无效）与与大多数高危患者讨论身体活动和将他们转介到强化行为咨询均显著相关（调整后的优势比，1.92；95%置信区间，1.15-3.20）。系统层面的障碍（例如，转诊服务不可用）则不然。只有略多于一半的 PCP 与大多数高危患者讨论了身体活动，很少有 PCP 既讨论了身体活动又将患者转介到强化行为咨询。克服与身体活动咨询相关的态度和信念方面的障碍，可能有助于提高咨询和将患者转介到强化行为咨询以预防 CVD 的水平。
