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Stress Management Counseling in the Primary Care Setting Is Rare

While stress may be a factor in 60% to 80% of all visits to primary care physicians, only 3% of patients actually receive stress management counseling, say researchers at Beth Israel Deaconess Medical Center (BIDMC). The study appears online in the Archives of Internal Medicine.

“Almost half of Americans report an increase in psychological stress over the past five years. Stress is the elephant in the room. Everyone knows it’s there, but physicians rarely talk to patients about it,” says lead author Aditi Nerurkar, MD, MPH, a primary care 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 3% 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 primary care physicians 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 Medicine 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.”

— Source: Beth Israel Deaconess Medical Center