Stress management counselling in the primary care setting is rare

November 19, 2012

While stress may be a factor in 60 to 80 percent of all visits to primary care physicians, only three percent of patients actually receive stress management counseling, say researchers at Beth Israel Deaconess Medical Center.

The study appears online Nov. 19 in the .

"Almost half of Americans report an increase in over the past five years. Stress is the elephant in the room. Everyone knows it's there, but rarely talk to patients about it," says lead author, Aditi Nerurkar, MD, MPH a physician and the Assistant Medical Director of BIDMC's Cheng & Tsui Center for Integrative Care. "In fact, stress management counseling is the least common type of physician counseling, falling behind counseling for nutrition, exercise, weight loss and smoking."

Nerurkar and colleagues examined data from the 2006 to 2009 National Ambulatory Medical Care Survey involving more than 34,000 office visits and 1,263 physicians. They were looking for evidence of doctors who provided stress management help, which included counseling at the visit, providing "information intended to help patients reduces stress through exercise, biofeedback, yoga, etc.," or referrals "to other health professionals for the purpose of coping with stress."

What they found is that stress management counseling by physicians rarely happens in the primary care setting. Just three percent of physicians offer stress counseling, mostly for their more complex patients, particularly those coping with depression.

"Our research suggests that physicians are not providing stress management counseling as prevention, but rather, as a downstream intervention for their sickest patients," says Nerurkar. "Considering what we know about stress and disease, this clearly points to missed opportunities."

The researchers also found that stress management counseling was associated with longer office visits.

"We know that are overburdened. With the volume of patients they see, there simply may not be enough time to provide stress management counseling during the office visit," says senior author, Gloria Yeh, MD, MPH, Director of the Integrative Fellowship Program at Harvard Medical School and BIDMC. "The fact that we found that so few physicians are counseling their patients about stress supports this, and highlights the need to rethink how primary care is being delivered."

A key step towards incorporating stress management counseling into primary care may be restructuring primary care delivery and payment to support team-based care.

"New payment models designed to promote wellness will enable team-based primary care practices to add counseling and coaching staff to address stress, mental illness and behavioral change more effectively," says co-author, Russell S. Phillips, MD, Director of the Harvard Medical School Center for Primary Care.

These changes could help shift counseling to earlier in the disease process.

"Our findings make us wonder whether stress management counseling, if offered earlier to more as prevention, could lead to better health outcomes," says Nerurkar, "But more research is needed to establish the role that might play clinically."

Explore further: Primary care-based weight intervention helps obese patients reduce weight

Related Stories

Primary care-based weight intervention helps obese patients reduce weight

November 14, 2011
Can a visit to your primary care doctor help you lose weight? Primary care physicians, working with medical assistants in their practices, helped one group of their obese patients lose an average of 10.1 lb during a two-year ...

Weight-loss counseling most prevalent between male physicians and obese men

May 6, 2011
A study published in the June 2011 issue of the American Journal of Preventive Medicine examined the association between patient–physician gender concordance and weight-related counseling in obese individuals. Investigators ...

Smokers with comorbid conditions need help from their doctor to quit

August 23, 2011
Smokers who also have alcohol, drug and mental disorders would benefit greatly from smoking cession counseling from their primary care physicians and would be five times more successful at kicking the habit, a study by researchers ...

Health-care providers are prescribing nontraditional medicine

May 9, 2011
More than a third of Americans use some form of complementary and alternative medicine (CAM) and that number continues to rise attributed mostly to increases in the use of mind-body therapies (MBT) like yoga, meditation and ...

Lifestyle counseling reduces time to reach treatment goals for people with diabetes

January 24, 2012
Lifestyle counseling, practiced as part of routine care for people with diabetes, helps people more quickly lower blood glucose, blood pressure and cholesterol levels and keep them under control, according to a large, long-term ...

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

Three million Americans carry loaded handguns daily, study finds

October 19, 2017
An estimated 3 million adult American handgun owners carry a firearm loaded and on their person on a daily basis, and 9 million do so on a monthly basis, new research indicates. The vast majority cited protection as their ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.