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PubMed2006

Provision of smoking cessation counseling by general practitioners assisted by training and screening procedure.

OBJECTIVE: To examine which counseling behavior among GPs can be achieved after counseling training when organizational support is provided. METHODS: A random sample of 39 general practices was drawn, 34 took part. GPs received a pre-study assessment followed by a training session for smoking counseling. All patients showing up during a period of 1 week were asked about smoking status. Current smokers, aged 18-70 years were eligible (N=551), 81.8% participated. A documentation sheet, filled in by a study nurse transferred smoking-related information about patient to the GP. GPs were advised to fill in a post-counseling assessment for every patient. A post-study assessment with the GPs was conducted. RESULTS: Frequent barriers for smoking counseling were lack of time and the assumption that patients were not motivated to quit. The GP's documented smoking counseling in 96.0%. The patients (87.8%) could be thoroughly counseled. Younger age of the GP, a high number of patients and the contemplation stage quitting smoking were predictors for realizing counseling. 79.3% of the GPs assessed the procedure to be practicable. CONCLUSIONS: Smoking counseling in the general practice is feasible. PRACTICE IMPLICATION: Involving staff in the screening procedure may support counseling activity of the GP.

Adolescent↗
PubMed2003

The association between counseling, sun protection, and early detection of skin cancer in middle-aged Israelis.

BACKGROUND: Healthcare professionals' counseling is expected to prompt primary and secondary prevention of skin cancer. In this study, we evaluated the association between counseling on skin cancer prevention and early detection and the recommended behaviors in middle-aged people. METHODS: A random national cross-sectional telephone survey of 793 Israeli residents, aged 45-75 years, was conducted. The interviewees reported healthcare professionals' counseling and self-reported behaviors associated with sun protection and early detection of skin cancer. RESULTS: Counseling on sun protection was reported by less than 10% of respondents. The presence of self-reported skin-cancer risk factors was significantly associated both with sun protection counseling and behavior. However, there was no association between sun protection counseling and behavior in a regression model. The rate of counseling on self-skin examination among respondents with self-reported skin-cancer risk factors was 17%. Early detection behaviors were significantly associated with practitioner's counseling on this issue. CONCLUSION: Healthcare professionals' counseling on secondary skin cancer prevention seems to have a greater impact on behaviors than primary prevention counseling in middle-aged people and calls for improvement of primary prevention by health care professionals.

Aged↗
PubMed2002

Direct observation of nutrition counseling in community family practice.

BACKGROUND: Despite the large potential of dietary changes to reduce morbidity and mortality, the frequency, time spent, and factors associated with nutrition counseling in primary care are not well studied. METHODS: In a cross-sectional study of 84 family physician practices in northeast Ohio, nutrition counseling was measured by direct observation on 2 days for all consecutive ambulatory visits. The frequency, time spent, and patient and visit characteristics associated with nutrition counseling were determined. RESULTS: Among 138 family physicians, only 6% included nutrition counseling in the majority (>50%) of patient encounters. Among 3475 consecutive outpatient visits in adults, nutrition counseling occurred in 24% of all patient visits, 17% of visits for acute illnesses, 30% of chronic illness visits, and 41% of well-care visits. The average time spent on nutrition counseling was 55 seconds, ranging from <20 seconds to >6 minutes. Nutrition counseling occurred in 45% of visits for diabetes, 25% of visits for cardiovascular disease, 31% of visits for hypertension, 26% of prenatal visits, and 33% of visits by obese patients (body mass index >30). Nutrition counseling was more likely to occur during visits by patients who were older or had diabetes mellitus, during visits for well care or chronic illness, and during longer visits. CONCLUSION: Despite considerable variability from physician to physician, nutrition counseling occurs in approximately one fourth of all office visits to family physicians. The observed efforts by family physicians to focus nutrition counseling on high-risk patients may increase its impact.

Adult↗
PubMedDate not supplied

Asthma patients' satisfaction with the frequency and content of pharmacist counseling.

OBJECTIVE: To assess the level of expectation and satisfaction of patients with asthma regarding the counseling provided by community pharmacists, and to identify the counseling information patients consider important in helping them manage their asthma. DESIGN: Mailed survey. PARTICIPANTS: 208 patients seen in the University of Utah Asthma Clinic for at least 3 months, age 18 years or older, and on at least 1 asthma medication. MAIN OUTCOME MEASURES: Frequency of pharmacist-provided asthma medication counseling, patients' perception of the importance of counseling, and their satisfaction with counseling. RESULTS: Response rate was 55% (106 of 194 surveys returned). The majority of patients (> 90%) indicated that their community pharmacist "never" or "sometimes" discussed the management of their asthma with them. Frequency of counseling in three predefined areas of asthma education (role of medications, inhaler technique, and prevention of asthma attacks) was 1.91, 1.72, and 1.31, respectively (1 = never, 4 = always). Most patients (76%) considered these areas of counseling to be important for the management of their asthma. Most patients (62%) were "somewhat" to "pretty" satisfied with the type and amount of asthma counseling provided by their pharmacist. Counseling sessions averaged less than 3 minutes. Only 25% of patients would be willing to pay an additional amount for pharmaceutical care. CONCLUSION: Self-reported rates of patient counseling concerning asthma medications in the community pharmacy setting are low and adequately address neither the educational needs of patients nor the recommendations of the National Asthma Education and Prevention Program.

Adult↗
PubMedDate not supplied

Patient-guided counseling in the community pharmacy setting.

OBJECTIVE: To test a new prescription counseling method termed "patient-guided counseling" (PGC) in community pharmacies. DESIGN: Post-test experimental design in which subjects were randomized to three groups. SETTING: Six community pharmacies (three chain and three independent). PATIENTS: Patients presenting new prescriptions. INTERVENTIONS: Patients were randomly assigned to one of three comparison groups. The PGC group was given a written prompt instructing them to write any questions they wished to ask about their prescription or their medical condition. The pharmacist then incorporated these questions into the subsequent verbal counseling. A second group was given a written prompt encouraging them to ask the pharmacist questions. This was followed by customary verbal counseling. A third group served as the control. No prompts were provided, but the pharmacist did provide customary verbal counseling. MAIN OUTCOME MEASURES: Patients' demographics, recall of medication information, and satisfaction with counseling. Patients were contacted by telephone 5 days after the start of drug therapy to measure compliance. Pharmacists rated their satisfaction with the information communicated and with their interactions with patients. RESULTS: Compared with customary verbal counseling, the PGC method was associated with more supplemental questions asked by the patient. Compared with the other two methods, PGC was associated with greater pharmacist satisfaction with the information communicated and slightly longer counseling sessions. No significant differences were found for patients' overall satisfaction with counseling, recall of information, and compliance. CONCLUSION: In the community pharmacy setting, PGC fosters patient participation in medication counseling, a necessary element for the provision of pharmaceutical care.

Community Pharmacy Services↗
PubMed2006

A narrative therapy approach to counseling: a model for working with adolescents and adults with language-literacy deficits.

PURPOSE: Remediation efforts with adolescents and adults with language-literacy deficits (LLD) may be hindered by concomitant factors such as decreased self-esteem and self-efficacy. Despite sound linguistically based remediation practices, treatment lacking integrated counseling components may fail to achieve optimal outcomes. In this tutorial, we recount a counseling approach, specifically a narrative therapy counseling approach based on constructivist theory, to be used with adolescents and adults with LLD. METHOD: A review of the literature includes research on the use of counseling in communication disorders settings and on the application of a narrative therapy counseling approach with individuals with decreased self-esteem. The key components and steps of narrative therapy are described, and applications for use with adolescents and adults with LLD are suggested. Sample vignettes of a counseling component for a 22-year-old student with LLD who is enrolled in literacy intervention are used to illustrate some of the key points of a narrative therapy counseling approach. IMPLICATIONS: A narrative therapy counseling approach that is integrated into language-literacy remediation may be an effective way of addressing concomitant factors such as decreased self-esteem in adolescents and adults with LLD. Readers of this article are challenged to seek additional counseling training and to begin to conduct research to determine the feasibility, effectiveness, and efficacy of integrating a counseling component into speech and language therapy.

Adolescent↗
PubMed2005

Teratogen risk counselling by internet: a prospective cohort study.

Although the internet may play a role in providing proper teratogen-risk counselling for pregnant women, the experience with this type of service has not been reported. We aimed to compare the pregnancy outcome of women counselled by the internet to women that received typically in-clinic teratogen risk counselling in the clinic. In a prospective cohort design, 1,011 patients were counselled in the clinic and 235 patients were counselled via the internet. Teratogen risk counselling was provided according with the information obtained from medical literature and specialised software. Information about pregnancy outcome (delivery, spontaneous abortion, or termination of pregnancy and major malformations) was obtained from 903 (89.3%) patients from the clinic group and 141 (60%) from the internet group. The amount of alcohol, cigarettes smoked, and millirads of X-ray were greater ( p < 0.05) in patients counselled by internet than in clinic. The rate of deliveries, ongoing pregnancies, pregnancy terminations, and spontaneous abortions were similar between clinic and internet (chi2 = 1.32; p = 0.7). Of 498 babies born to mothers counselled in the clinic, major malformations were identified in 3.6%. Of 67 babies born to mothers counselled by internet, major malformations were present in 1.5% ( p = 0.6). Teratogen-risk counselling by internet and clinic seems to have a similar efficacy in pregnancy outcome.

Abnormalities, Drug-Induced↗
PubMed2002

Comprehensive genetic counseling for families at risk for HNPCC: impact on distress and perceptions.

The aim of the study was to explore distress and health beliefs before and after comprehensive interdisciplinary counseling in families at risk for hereditary non-polyposis colorectal cancer (HNPCC). Results reported here were derived from a consecutive sample of 65 counselees [31 patients with colorectal cancer (CRC) and 34 unaffected at-risk persons] who participated in interdisciplinary counseling provided by human geneticists, surgeons, and psycho-oncologists before genetic testing. Data were collected from self-administered questionnaires before, as well as 4-6 weeks after, counseling. Distress and perceptions specific to HNPCC were assessed at both timepoints using standardized as well as author-derived instruments. Distress declined after counseling, as did worries related to HNPCC. An increase was found in personal belief in control of cancer risk, for instance, in the perceived efficacy of early detection of CRC. We also observed a trend toward greater anticipated ability to cope with a positive gene test after counseling. Changes after counseling were generally more pronounced for persons at risk, as compared to patients with cancer. The decrease in distress was partly attributable to an increase in personal self-confidence. One-third of the sample reported enhanced communication specific to hereditary disease within the family after counseling. A substantial minority, however, said they experienced increased worry and physical symptoms after counseling. Overall, counselees demonstrated less stress and perceived cancer threat as well as enhanced beliefs regarding personal control over cancer, suggesting an overall beneficial impact of comprehensive counseling. Further research is needed to identify those individuals most at risk for increased fear and worry related to HNPCC so that they may be most appropriately counseled.

Adult↗
PubMed2005

An empirical examination of client attitudes towards online counseling.

Trends over the past decade have shown that online counseling has grown in terms of popularity among consumers and clinicians alike; however, little, if any empirical evidence exists that examines client attitudes towards online counseling as alternative to traditional face-to-face therapy. Therefore, this study investigated client attitudes towards online counseling. Data was collected from 48 e-clients who received online counseling at the Center for Online Addiction. Variables such as client perceptions and concerns about using online counseling, clients' reasons for seeking online counseling over in-office treatment, and demographic profiles of e-clients were assessed. Results suggested that Caucasian, middle-aged males, with at least a four-year bachelors degree were most likely to use online counseling and anonymity, convenience, and counselor credentials were the most cited reasons they sought online counseling over in-office treatment. The lack of perceived privacy and security during online chat sessions and the fear of being caught while conducting online sessions were the main concerns reported by e-clients. A better understanding of client motives and perceptions towards online counseling helps to guide treatment in using the Internet as a clinical tool, especially as the Internet becomes increasingly more available in previously remote markets and the field of online counseling continues to grow.

Adult↗
PubMed2005

Influence of long-term intervention with dietary counseling, long-chain n-3 fatty acid supplements, or both on circulating markers of endothelial activation in men with long-standing hyperlipidemia.

BACKGROUND: Dietary factors and very-long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) may influence the atherothrombotic process. Elevated concentrations of circulating cell adhesion molecules, thrombomodulin (TM), von Willebrand factor (vWF), and tissue-type plasminogen activator antigen (tPAag) are related to atherothrombotic cardiovascular disease. OBJECTIVE: The randomized Diet and Omega-3 Intervention Trial (DOIT) targeted a comparison of the effect of 3-y dietary counseling, n-3 PUFA supplementation (2.4 g/d), or both on circulating markers of endothelial activation. DESIGN: The study included 563 elderly men with long-standing hyperlipidemia. The men were randomly assigned by factorial design into 4 groups: control (no dietary counseling and placebo capsules), dietary counseling (and placebo capsules), n-3 PUFA supplementation (no dietary counseling), and dietary counseling and n-3 PUFA supplementation. RESULTS: Serum concentrations of fatty acids reflected good compliance. Dietary counseling was followed by significantly reduced concentrations of soluble intercellular adhesion molecule 1 (sICAM-1; P < 0.001), sTM (P = 0.004), and tPAag (P < 0.001) than in subjects without dietary counseling. After n-3 PUFA supplementation, significantly reduced concentrations of sICAM-1 (P < 0.001) and sTM (P = 0.006) were observed when compared with subjects receiving placebo capsules. An increase in tPAag was not significantly different from that observed in subjects receiving placebo capsules. For sICAM-1, a significant effect was observed for both interventions combined. CONCLUSIONS: Each intervention (dietary counseling or n-3 PUFA supplements) reduced sTM and sICAM-1 concentrations, indicating decreased endothelial activation. The tPAag increase in the groups not receiving dietary counseling (pooled), which indicates progression of atherosclerosis, was significantly counteracted by dietary counseling.

Aged↗
PubMed1998

Staff development in pharmacist-conducted patient education and counseling.

A staff development program designed to improve pharmacists' counseling skills and to allow participants to achieve a minimum level of competence in counseling is described. The pharmacy service at a Department of Veterans Affairs medical center selected a workshop emphasizing the principles of the Indian Health Service (IHS) interactive counseling technique as the basis for a training program for staff pharmacists. The program was expanded to meet the pharmacy's counseling training needs. Handouts on 70 of the most frequently prescribed outpatient medications; administration techniques for oral and nasal inhalers and ophthalmic agents; and 32 common diseases were included in training manuals. Seven standard cases were developed for role-playing sessions, the purpose of which was to increase pharmacists' level of confidence in using the IHS technique and in counseling patients about common diseases and medications. Each pharmacist's counseling technique was assessed by a facilitator. Knowledge of commonly prescribed medications was assessed by an open-book written examination. The pharmacists' self-reported level of confidence in counseling patients about common diseases and medications was significantly improved after the training program. A counseling training program enabled pharmacists to achieve a minimum level of competence in counseling and increased their confidence in their counseling skills.

California↗
PubMed2001

Guidelines for counselling in infertility: outline version.

The Guidelines for Counselling in Infertility describe the purpose, objectives, typical issues and communication skills involved in providing psychosocial care to individuals using fertility services. The Guidelines are presented in six sections. The first section describes how infertility consultations differ from other medical consultations in obstetrics and gynaecology, whereas the second section addresses fundamental issues in counselling, such as what is counselling in infertility, who should counsel and who is likely to need counselling. Section 3 focuses on how to integrate patient-centred care and counselling into routine medical treatment and section 4 highlights some of the special situations which can provoke the need for counselling (e.g. facing the end of treatment, sexual problems). Section 5 deals exclusively with third party reproduction and the psychosocial implications of gamete donation, surrogacy and adoption for heterosexual and gay couples and single women without partners. The final section of the Guidelines is concerned with psychosocial services that can be used to supplement counselling services in fertility clinics: written psychosocial information, telephone counselling, self-help groups and professionally facilitated group work. This paper summarizes the different sections of the Guidelines and describes how to obtain the complete text of the Guidelines for Counselling in Infertility.

Counseling↗
PubMed2003

Results from a prospective, randomized, controlled study evaluating the acceptability and effects of routine pre-IVF counselling.

BACKGROUND: The aim of this study was to evaluate a model of routine pre-IVF counselling focusing on the narrative capacities of couples. The acceptability of counselling, the effects on emotional factors and the participants' assessments were considered. METHODS: The study included 141 consecutive childless couples preparing for their first IVF. Randomization was carried out through sealed envelopes attributing participants to counselled and non-counselled groups and was accepted by 100 couples. Another 12 couples refused randomization because they wanted counselling and 29 because they did not. Questionnaires including the State-Trait Anxiety Inventory, the Beck Depression Inventory and assessments of help were mailed to couples before IVF and counselling, and after the IVF outcome. RESULTS: Counselling was accepted by 79% (112/141) of couples. There was no significant effect of counselling on anxiety and depression scores which were within normal ranges at both times. Counselling provided help for 86% (75/87) of initially non-demanding subjects and 96% (25/26) of those initially requesting a session. Help was noted in areas of psychological assistance, technical explanations and discussing relationships. CONCLUSIONS: This model of routine counselling centred on the narrative provides an acceptable form of psychological assistance for pre-IVF couples.

Adult↗
PubMed1995

Effects of individualized breast cancer risk counseling: a randomized trial.

BACKGROUND: Studies have shown that a majority of women with a family history of breast cancer have exaggerated perceptions of their own risk of this disease and experience excessive anxiety. In response to the need to communicate more accurate risk information to these women, specialized programs for breast cancer risk counseling have been initiated in medical centers across the United States. PURPOSE: Our purpose was 1) to evaluate the impact of a standardized protocol for individualized breast cancer risk counseling on comprehension of personal risk among first-degree relatives of index breast cancer patients and 2) to identify women most and least likely to benefit from such counseling. METHODS: This study is a prospective randomized trial comparing individualized breast cancer risk counseling to general health counseling (control). We studied 200 women aged 35 years and older who had a family history of breast cancer in a first-degree relative. Women with a personal history of cancer were excluded. Risk comprehension was assessed as the concordance between perceived "subjective" lifetime breast cancer risk and estimated "objective" lifetime risk. RESULTS: The results of logistic regression analysis showed that women who received risk counseling were significantly more likely to improve their risk comprehension, compared with women in the control condition (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.3-9.5; P = .01). However, in both groups, about two thirds of women continued to overestimate their lifetime risks substantially following counseling. Examination of subjects by treatment interaction effects indicated that risk counseling did not produce improved comprehension among the large proportion of women who had high levels of anxious preoccupation with breast cancer at base line (P = .02). In addition, white women were less likely to benefit than African-American women (OR = 0.34; 95% CI = 0.11-0.99; P = .05). CONCLUSION: Efforts to counsel women about their breast cancer risks are not likely to be effective unless their breast cancer anxieties are also addressed. IMPLICATIONS: Attention to the psychological aspects of breast cancer risk will be critical in the development of risk-counseling programs that incorporate testing for the recently cloned breast cancer susceptibility gene, BRCA1 (and BRCA2 when that gene has also been cloned).

Adult↗
PubMed2003

Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments?

OBJECTIVES: To estimate the frequency of HIV/sexually transmitted disease (STD) counseling among patients tested for HIV or STD infection at physician offices and hospital outpatient departments and to describe the factors associated with HIV/STD counseling in private settings in the USA. DESIGN: Cross-sectional study of patients served by physicians in private settings in the USA. METHODS: We analyzed 1997-1998 data from two representative national surveys of ambulatory care visits in private settings by persons aged 18-64 years. RESULTS: During 1997-1998, 12.7 million ambulatory care visits included HIV or STD testing. HIV/STD counseling was documented in 35% of all visits and in 28% of visits by pregnant women at the time HIV or STD tests were done. Counseling was less common when only HIV tests (21%) or STD tests (37%) alone were carried out than when both HIV and STD tests (50%) were performed. Counseling was more common (65%) if the patient's reason for visit was related to HIV, STD, or genitourinary complaints than if the visit was for other reasons. CONCLUSIONS: Private physicians often counseled about HIV/STD when testing patients with symptoms. The proportion of other visits in which counseling accompanied HIV or STD tests was variable. This suggests the need for a better understanding of the reasons why clinicians in private settings decide whether to counsel patients about HIV and STD when they order testing, barriers to offering counseling, and interventions to increase counseling when appropriate.

Adolescent↗
PubMedDate not supplied

The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care.

OBJECTIVE: The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care. DESIGN: During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years postmenopausal. Most (86.0%) were Caucasian, and their median annual income was approximately $40,000. Nearly all (90.8%) had medical insurance coverage; 47.6% of those insured received care from a managed care organization. Access to medical care was evidenced by 92.3% being under the care of a primary care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determination. RESULTS: Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from healthcare providers. Both level of education and level of income were associated with an increased likelihood that HRT counseling would be obtained. Having a personal physician, and particularly receiving care from a gynecologist, increased the likelihood that counseling would be available. There were no substantial differences in counseling frequency between women in managed care plans and those having other types of health insurance. In a multivariate model, adjusted odds ratios for receiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) for having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other primary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not. CONCLUSIONS: Three quarters of a sample of US postmenopausal women aged 50-65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care physician were least likely to have received counseling. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.

Counseling↗
PubMed2004

Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission.

To determine effect of partner involvement and couple counseling on uptake of interventions to prevent HIV-1 transmission, women attending a Nairobi antenatal clinic were encouraged to return with partners for voluntary HIV-1 counseling and testing (VCT) and offered individual or couple posttest counseling. Nevirapine was provided to HIV-1-seropositive women and condoms distributed to all participants. Among 2104 women accepting testing, 308 (15%) had partners participate in VCT, of whom 116 (38%) were couple counseled. Thirty-two (10%) of 314 HIV-1-seropositive women came with partners for VCT; these women were 3-fold more likely to return for nevirapine (P = 0.02) and to report administering nevirapine at delivery (P = 0.009). Nevirapine use was reported by 88% of HIV-infected women who were couple counseled, 67% whose partners came but were not couple counseled, and 45%whose partners did not present for VCT (P for trend = 0.006). HIV-1-seropositive women receiving couple counseling were 5-fold more likely to avoid breast-feeding (P = 0.03) compared with those counseled individually. Partner notification of HIV-1-positive results was reported by 138 women (64%) and was associated with 4-fold greater likelihood of condom use (P = 0.004). Partner participation in VCT and couple counseling increased uptake of nevirapine and formula feeding. Antenatal couple counseling may be a useful strategy to promote HIV-1 prevention interventions.

AIDS Serodiagnosis↗
PubMed2004

Prevalence of nutrition and exercise counseling for patients with hypertension. United States, 1999 to 2000.

OBJECTIVE: To evaluate the prevalence of nutrition and exercise counseling for patients with hypertension. DESIGN: Cross-sectional survey data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1999 and 2000. SETTING: Office-based physician practices and hospital outpatient departments. PATIENTS/PARTICIPANTS: Patients age 18 or older with a diagnosis of hypertension. MEASUREMENTS AND MAIN RESULTS: In 1999 and 2000, over 137 million patient encounters had a diagnosis of hypertension. Nutrition and exercise counseling were provided at 35% and 26% of visits, respectively. Patients older than 74 received the least nutrition (28%) and exercise (18%) counseling. Asians and Hispanics were more likely to undergo any lifestyle counseling, while non-Hispanic whites received the least exercise and nutrition counseling. Patients with 2 cardiovascular comorbidities were counseled for diet (53%) and exercise (32%) more than those with 1 (44% and 31%) or none (30% and 23%; P</=.001 and P</=.001). The encounters in the NAMCS had higher rates of counseling than those in the NHAMCS. There were no significant differences in counseling rates with respect to gender, geographic region, severity of hypertension, or physician specialty. CONCLUSIONS: While there were significant differences in counseling rates with respect to age, race, comorbidity, and survey cohort, counseling for therapeutic lifestyle changes for patients with hypertension was uniformly suboptimal. Physicians need to recognize the importance of nonpharmacologic treatment in hypertension.

Adolescent↗