Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Primary Care Providers’ Recommendations for Hypertension Prevention, DocStyles Survey, 2012:

Primary Care Providers’ Recommendations for Hypertension Prevention, DocStyles Survey, 2012: Background: Healthy behaviors, including maintaining an ideal body weight, eating a healthy diet, being physically active, limiting alcohol intake, and not smoking, can help prevent hypertension. The objective of this study was to determine the prevalence of recommending these behaviors to patients by primary care providers (PCPs) and to assess what PCP characteristics, if any, were associated with making the recommendations. Methods: DocStyles 2012, a Web-based panel survey, was used to assess PCPs’ demographic characteristics, health-related behaviors, practice setting, and prevalence of making selected recommendations to prevent hypertension. Logistic regression was used to calculate the odds of making all 6 recommendations, by demographic, professional, or personal health behavior characteristics. Results: Overall, 1253 PCPs responded to the survey (537 family physicians, 464 internists, and 252 nurse practitioners). To prevent hypertension, 89.4% recommended a healthy diet, 89.9% recommended lower salt intake, 90.3% recommended maintaining a healthy weight, 69.4% recommended limiting alcohol intake, 95.1% recommended being physically active, and 90.4% recommended smoking cessation for their patients who smoked. More than half (56.1%) of PCPs recommended all 6 healthy behaviors. PCPs’ demographic characteristics and practice setting were not associated with recommending all 6. PCPs who reported participating in regular physical activity (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.05-2.67) and eating healthy diet (OR 1.68, 95% CI 1.11-2.56) were more likely to offer all 6 healthy behavior recommendations than those without these behaviors. Conclusion: Most PCPs recommended healthy behaviors to their adult patients to prevent hypertension. PCPs’ own healthy behaviors were associated with their recommendations. Preventing hypertension is a multifactorial effort, and in the clinical environment, PCPs have frequent opportunities to model and promote healthy lifestyles to their patients. Keywords primary care providers, hypertension (high blood pressure), prevention, healthy behaviors 10-12 motivate patients to adopt healthy behaviors. We sought Background to assess the prevalence of PCPs’ recommendations to pre- Cardiovascular disease is the leading cause of death in the vent hypertension and the factors that influence them to United States, and hypertension is a primary contributing make such recommendations. 1-3 factor. Risk factors for hypertension are well known and include modifiable behaviors (eg, physical inactivity, Methods unhealthy diet, overweight and obesity, excess alcohol consumption, smoking) and nonmodifiable factors (eg, DocStyles is a Web-based panel survey conducted by Porter family history of hypertension, age, gender, race/ethnicity). Novelli. The survey participants were family and general Current guidelines for the primary prevention of hyperten- physicians, internists, and nurse practitioners. In 2012, sion target modifiable risk behaviors. The most common places clinical care services are provided are primary care National Center for Chronic Disease Prevention and Health Promotion, provider (PCP) offices. In the United States, PCP visits Centers for Disease Control and Prevention, Atlanta, GA, USA account for more than half of all ambulatory care visits. For Corresponding Author: example, 62% of the 1.1 billion ambulatory visits were made Jing Fang, Division for Heart Disease and Stroke Prevention, National to primary care sites in 2008. This frequent interaction of Center for Chronic Disease Prevention and Health Promotion, Centers patients and PCPs creates ongoing opportunities to promote for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-72, the prevention of hypertension to a large population. Advice Atlanta, GA 30341, USA. 8,9 from PCPs has been shown to influence behaviors and to Email: [email protected] Fang et al 171 DocStyles was conducted from June to July, and participants analysis of variance tests for continuous variables. The were eligible if they had been in clinical practice for a mini- association of PCPs’ demographic characteristics and their mum of 3 years; worked at an individual, group, or hospital recommendations for hypertension prevention were practice in the United States; and saw at least 10 patients per assessed with chi-square tests. The odds of providing all 6 week. Physicians and nurse practitioners were selected from healthy behavior recommendations, adjusting for demo- separate volunteer panels. Physicians were randomly selected graphic characteristics (age, sex, race/ethnicity) and spe- from the Epocrates Honors Panel (n ≥ 275 000) and matched cialty, were assessed by logistic regression models. Other to the American Medical Association master file proportions variables (eg, physical activity, fruit or vegetable intake, for age, sex, and region. Nurse practitioners were randomly years in practice, practice setting) were added into the mod- selected from the Epocrates’ Allied Health Panel (n ≥ 78 000). els if the P was less than .2 in univariate analysis. All analy- Quotas were set to reach 1000 PCPs and 250 nurse practitio- ses were conducted using SAS software (version 9.3, SAS ners. Physicians and nurse practitioners from both panels Institute, Inc, Cary, NC). were invited to participate by e-mail. Participation was vol- untary, and respondents could exit the survey at any time. Results Those who completed the survey received an honorarium of $20 to $85, which varied depending on the skip patterns and A total of 1253 PCPs completed the survey (537 family length of the survey. The overall response rates were calcu- physicians, 464 internists, and 252 nurse practitioners). The lated using a formula that included total sample contacted, response rate was 52.2% (physicians = 49.9%, nurse practi- surveys completed, incomplete surveys, respondents not tioners = 65.4%). We found significant differences by PCP meeting screening criteria, nonresponse, and respondents specialty for demographic characteristics (gender, race/eth- removed from the eligible sample because quotas were filled. nicity), adequate fruit and vegetable consumption, and The survey asked about PCPs’ demographic characteris- practice characteristics (years in practice and practice set- tics (age, sex, race/ethnicity) and medical practice (spe- ting) (Table 1). cialty, setting, years in practice, teaching hospital privileges, A high percentage of PCPs recommended most hyperten- financial situation of the majority of their patients). sion prevention measures (Table 2). Overall, 89.4% recom- Questions about health-related behaviors included fruit or mended eating a healthy diet, 89.9% recommended reducing vegetable consumption (days per week consuming ≥5 cups salt intake, 90.3% recommended attaining or maintaining a of fruits or vegetables), current smoking (days per week healthy weight, 95.1% recommended physical activity, and smoking cigarettes, cigars, or pipes), and physical activity 90.4% recommended smoking cessation to their patients (days per week doing ≥30 minutes of physical activity). who smoked. However, only 69.4% recommended limiting Respondents also reported height and weight, which were alcohol intake. In general, the prevalence of recommending used to calculate body mass index (units of kg/m ). these behaviors was higher among PCPs who were older, Primary care providers’ hypertension prevention recom- classified as a nurse practitioner, who reported adequate fruit mendations were assessed with the question, “What types or vegetable intake, and who did not smoke. of advice do you give adult patients about preventing high Overall, 56.1% of PCPs reported that they made all 6 blood pressure?” Available responses were “Eat a healthy hypertension prevention recommendations. After adjust- diet,” “Cut down on salt,” “Attain or maintain a healthy ment, there were no significant differences in making all 6 weight,” “Get enough sleep each night,” “Limit the use of recommendations by PCP age, sex, race/ethnicity, body alcohol,” “Be physically active,” “Smoking cessation,” mass index, smoking status, specialty, or practice setting. “Take nutritional supplements,” “Try relaxation methods,” However, making all 6 recommendations was more likely “Get intellectual stimulation,” and “None of these.” among PCPs who reported consuming the recommended amount of fruits or vegetables and among those who engaged in the recommended amount of physical activity Statistical Analyses compared with those who did not (Table 3). Recommendations in agreement with current guidelines for hypertension prevention were selected for analysis: eat Discussion healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use, be physically active, and smoking The principal findings of current study is that most PCPs, cessation. We measured the prevalence of PCPs’ reported according to their self-reported statement, provided evi- hypertension prevention recommendations independently and denced-based hypertension prevention recommendations to collectively (ie, all 6 healthy behavior recommendations). their adult patients that align with current guidelines: eating The differences in PCP characteristics by specialty (fam- a healthy diet, reducing dietary salt intake, attaining or ily physician, internist, and nurse practitioner) were maintaining a healthy weight, being physically active, and assessed with chi-square tests for categorical variables and quitting smoking (for their patients who smoke). However, 172 Journal of Primary Care & Community Health 6(3) Table 1. Demographic Characteristics, Health Behaviors, and Practice Characteristics of Respondents to the DocStyles 2012 Survey, by Primary Care Physician Specialty. Overall Family Physicians Internist Nurse Practitioner PCP Characteristic (N = 1253) (n = 537) (n = 464) (n = 252) P Mean age, y (SE) 47.0 (0.27) 46.7 (0.40) 46.5 (0.46) 48.5 (0.60) .022 Gender, % Male 59.5 70.0 72.6 12.7 <.001 Female 40.5 30.0 27.4 87.3 Race/ethnicity, % Non-Hispanic white 72.9 76.7 58.2 92.1 <.001 Non-Hispanic black 3.4 3.4 4.3 2.0 Non-Hispanic other 19.4 14.5 33.4 4.0 Hispanic 4.3 5.4 4.1 2.0 Body mass index (kg/m ), % .090 Normal (<25.0) 46.9 43.9 51.3 45.2 Overweight (25.0-29.9) 40.5 42.0 38.8 40.1 Obese (≥30.0) 12.6 14.1 9.9 14.7 ≥5 cups fruits or vegetables (days/week), % 0 10.1 11.0 10.1 7.9 .029 1-4 48.8 51.0 49.8 42.1 5-7 41.2 38.0 40.1 50.0 Smoking (days/week), % 0 95.5 96.1 94.4 96.4 .322 ≥1 4.5 3.9 5.6 3.6 ≥30 minutes physical activity (days/week), % 0 8.4 7.6 8.8 9.1 .575 1-4 62.7 63.0 64.5 59.1 5-7 28.9 29.4 26.7 31.8 Mean years in practice (SE) 15.5 (0.24) 15.8 (0.37) 16.0 (0.39) 13.6 (0.4) <.001 Main practice setting, % Individual practice 17.6 19.6 15.7 16.7 <.001 Group practice 73.3 78.2 64.0 79.8 Hospital or clinic 9.2 2.2 20.3 3.6 Has privileges at teaching 42.1 40.6 52.6 25.8 <.001 hospital, % Financial situation of majority of patients, % Poor to lower middle class 19.6 20.1 17.2 22.6 .076 Middle class 39.1 42.1 37.1 36.4 Upper middle class to affluent 41.3 37.8 45.7 40.9 Abbreviations: PCP, primary care provider; SE, standard error. Chi-square test or F test for differences in distributions by practice type. By PCP report. only 69.4% of PCPs recommended limiting alcohol intake consumption, physical inactivity, and smoking. National to prevent hypertension. Overall, 56.1% of PCPs said they health data have shown considerable room for improvement recommended all 6 healthy behaviors to reduce the risk of in these lifestyle behaviors and conditions. For example, hypertension for their adult patients. Furthermore, we found only 32.5% of US adults were consuming the recommended that PCPs who consumed the recommended amount of amount of fruits or vegetables in 2000-2009, less than fruits or vegetables and participated in the recommended 10% consumed <2300 mg sodium per day in 2003-2008, amount of physical activity were significantly more likely only 32.5% of adults were with classified as normal weight to recommend all 6 healthy behaviors. in 2005-2010, binge drinking prevalence was 17.1% in Hypertension prevention recommendations recognize a 2010, 20.6% of adults met both aerobic and muscle- number of modifiable risk factors, including an unhealthy strengthening physical activity guidelines in 2011, and diet, excess sodium intake, obesity, excess alcohol about 19.0% were current smokers in 2011. Fang et al 173 Table 2. Prevalence of Making Select Hypertension Prevention Recommendations Among Respondents to the DocStyles 2012 Survey, by Primary Care Provider (PCP) Characteristics. Smoking Cessation Healthy Reduce Salt Attain Healthy Limit Alcohol Be Physically for Patients Who PCP Characteristic Diet, % Intake, % Weight, % Use, % Active, % Smoke, % Total 89.4 89.9 90.3 69.4 95.1 90.4 Mean age, y a a a <45 88.7 89.1 87.2 65.7 93.4 89.8 ≥45 89.9 90.5 92.9 72.6 96.5 91.0 Gender a a Male 88.7 89.8 88.6 71.1 94.5 88.7 Female 90.4 90.0 92.7 67.0 95.9 92.9 Race/ethnicity a a Non-Hispanic white 89.5 88.2 91.6 68.8 96.0 90.2 Non-Hispanic black 95.4 100.0 90.7 69.8 100.0 97.7 Non-Hispanic other 88.1 93.4 86.4 70.0 91.4 89.3 Hispanic 88.7 94.3 84.9 77.4 92.5 94.3 Specialty a a a a Family physicians 90.5 88.6 90.9 71.9 95.9 93.1 Internist 86.2 92.0 87.5 67.7 92.9 85.1 Nurse practitioner 92.9 88.5 94.1 67.5 97.2 94.4 Body mass index, kg/m Normal (<25.0) 89.3 90.0 90.1 68.0 94.9 91.2 Overweight (25.0-29.9) 89.4 90.3 90.1 71.8 95.3 89.2 Obese (≥30.0) 89.9 88.0 91.1 67.1 94.9 91.8 ≥5 cups fruits or vegetables, days/week a a a 0 84.1 83.3 88.1 57.2 95.2 86.5 1-4 89.7 90.5 88.5 68.7 94.8 90.8 5-7 90.3 90.7 92.8 73.3 95.4 90.9 Smoking, days/week a a a a a 0 90.0 90.6 91.1 69.6 95.7 90.9 ≥1 76.8 73.2 71.4 66,1 80.4 80.4 ≥30 minutes physical activity, days/week 0 85.7 89.5 84.8 61.9 96.2 85.7 1-4 89.8 90.2 89.7 66.4 95.2 91.0 5-7 89.5 89.2 93.1 78.2 94.5 90.6 Years in practice <5 91.0 86.6 95.5 73.1 95.5 92.5 5-10 89.4 89.2 88.6 66.1 92.7 90.0 11-20 89.6 91.3 89.0 71.1 95.1 90.7 >20 88.7 89.3 92.8 69.9 97.4 90.2 Main practice setting Individual practice 90.5 90.9 90.9 71.8 94.6 92.7 Group practice 89.5 89.9 90.5 69.3 95.5 90.2 Hospital or clinic 86.1 87.8 87.0 66.1 92.2 87.8 Privileges at teaching hospital Yes 89.4 89.4 89.9 70.6 95.1 90.7 No 89.4 90.2 90.5 68.6 95.0 90.2 Financial situation of majority of patients Poor to lower middle class 88.2 90.6 91.8 67.3 94.7 90.6 Middle class 90.2 88.2 89.0 68.0 94.7 90.0 Upper middle class to affluent 89.2 91.1 90.8 71.8 95.6 90.7 Abbreviation: PCP, primary care provider. P < .05 using chi-square test comparing differences in recommending the activity. By PCP report. 174 Journal of Primary Care & Community Health 6(3) Table 3. Prevalence and Odd Ratios of Making All 6 Healthy Behavior Recommendations, Among Respondents to the DocStyles 2012 Survey, by Primary Care Provider Characteristics. PCP Characteristic Prevalence, % P OR (95% CI) P Age, y <45 53.6 .0926 1.00 ≥45 58.3 1.23 (0.97-1.56) .084 Gender Male 56.1 .999 1.12 (0.86-1.46) .398 Female 56.1 1.00 Race/ethnicity Non-Hispanic white 55.3 .590 0.85 (0.48-1.52) .583 Non-Hispanic black 65.1 1.64 (0.70-3.83) .257 Non-Hispanic other 57.6 1.12 (0.60-2.08) .724 Hispanics 56.6 1.00 Specialty Family physician 59.0 .054 0.99 (0.70-1.39) .935 Internist 51.7 0.70 (0.49-1.02) .060 Nurse practitioner 57.9 1.00 Body mass index, kg/m Normal (<25.0) 54.8 .664 Overweight (25-29.9) 57.2 Obese (≥30.0) 57.6 ≥5 cups fruits or vegetables, days/week 0 43.7 .006 1.00 1-4 55.8 1.59 (1.06-2.38) .024 5-7 59.5 1.68 (1.11-2.56) .015 Smoking, days/week 0 56.6 .077 1.68 (0.97-2.92) .064 ≥1 46.5 1.00 ≥30 minutes physical activity, days/week 0 48.6 <.001 1.00 1-4 53.4 1.13 (0.74-1.73) .571 5-7 64.9 1.68 (1.05-2.67) .030 Years in practice medicine <5 61.2 .590 5-10 55.6 11-20 57.5 >20 53.8 Main practice setting Individual practice 59.6 .341 Group practice 55.9 Hospital or clinic 51.3 Privileges at teaching hospital Yes 55.8 .847 No 56.3 Financial situation of majority of patients Poor to lower middle class 55.1 .288 Middle class 53.9 Upper middle class to affluent 58.7 Abbreviations: PCP, primary care provider; OR, odds ratio; CI, confidence interval. Eating a healthy diet, reducing salt intake, maintaining healthy weight, limiting alcohol use, being physically active, smoking cessation. Variables not included in the model (eg, body mass index, years in practice medicine, main practice setting, privileges at teaching hospital, financial situation of majority of patients) because their P value >.2 in univariate analysis. By PCP report. Fang et al 175 Primary care providers can influence patients’ decisions provide all 6 healthy behavior recommendations for to participate in healthy lifestyle behaviors. A randomized hypertension prevention to their adult patients. Ideally, controlled trial showed that patients who received counsel- each of the recommendations would be provided to ing on physical activity from general practitioners or family patients regularly, especially those at the highest risk, but physicians increased their level of physical activity signifi- PCPs are constantly faced with clinical time constraints cantly compared with those who did not receive counsel- and patients who have multiple comorbid conditions or 10,11 24 ing. A complementary study found that patients who urgent care needs. Alternate channels for hypertension received advice from their provider to quit smoking or exer- prevention recommendations are available. For example, cise more were more likely to report that they attempted team-based care, or the use of multidisciplinary profes- these actions. The study also showed that health care pro- sionals, inside and outside the clinical setting, has been vider’s advice on physical activity was the most effective used to promote health and manage health conditions. way to improve patients’ physical activity. The health care This structure is ideally suited for prevention messages, providers can maximize the success of increasing patients’ especially those for common serious conditions such as 19 25 physical activity level by repetition of the message. hypertension. We found that PCPs’ healthy behaviors, such as getting In 2011, the US Department of Health and Human the recommended amount of physical activity and consum- Services launched the Million Hearts initiative. By bringing ing the recommended amount of fruits or vegetables, were communities, health systems, nonprofit organizations, fed- associated with recommending behaviors to prevent high eral agencies, and private sector partners together, Million blood pressure, regardless of PCP demographic and clinical Hearts focuses on implementing evidence-based strategies practice characteristics. This report is consistent with an in the clinical and community environments to collectively earlier report that PCPs’ healthy behaviors are related to prevent 1 million heart attacks and strokes over a 5-year their recommendations for healthy lifestyle behavior man- period (2012-2017). Preventing and controlling hyperten- agement among patients with hypertension. Other studies sion is essential to achieving this objective, and requires a have also found that health care providers with healthier diverse range of activities, from changing the context and lifestyle behaviors were more likely to counsel patients to supports for a healthy lifestyle to individual interventions in stop smoking, exercise, manage their weight, and reduce the clinical setting. In each of these settings, evidence-based 21-23 their alcohol intake. interventions should be used when available. Resources Our results should be interpreted in the context of poten- such as the Guide for Community Preventive Services tial selection and reporting biases. First, this report was to (http://www.thecommunityguide.org) and the US Preventive assess the intent of the health care provider, rather than to Services Task Force (http://www.uspreventiveservices assess the actual advice provided to patients. What the taskforce.org) recommendations are available for practitio- health care providers said they did could be different from ners in diverse settings. what they really did. The social desirability of saying “Yes” In the clinical setting, PCPs are a trusted source of health (i.e., that they did make these recommendations) would information who interact with the general population. We overestimate the percentage reported compared with what found that PCPs were more likely to recommend healthy actually happened in clinical practice. Second, the survey lifestyle behaviors if they themselves participated in healthy only asked about recommendations in general. Thus, it is behaviors. Hypertension prevention is multifactorial and not clear how often PCPs made the recommendations, or will require coordinated care and programs in the clinical with what degree of enthusiasm, or if the advice varied by setting coupled with effective community-based supports comorbid conditions. To assess whether and how the PCPs for healthy behaviors. made the recommendations, we would need to use a combi- Authors’ Note nation of medical chart review and clinician reports. Third, the survey was not a nationally representative sample of The findings and conclusions in this report are those of the authors physicians or nurse practitioners, and thus the results may and do not necessarily represent the official position of the Centers for Disease Control and Prevention. not be generalizable. Finally, as a Web-based survey, the survey requires internet access and a basic familiarity with Declaration of Conflicting Interests internet-based surveys. While limitations do exist when using this survey platform, DocStyles is a large, national The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this survey conducted annually among a diverse group of PCPs, article. and allows for the collection of current information on health care provider attitudes and behaviors. Funding In this study, most PCPs stated that they provided evi- denced-based hypertension prevention recommendations The author(s) received no financial support for the research, to their patients, and just more than half stated that they authorship, and/or publication of this article. 176 Journal of Primary Care & Community Health 6(3) References 17. Centers for Disease Control and Prevention. Adult participation in aerobic and muscle-strengthening physical activities—United 1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and States, 2011. MMWR Morb Mortal Wkly Rep. 2013;62:326-330. stroke statistics—2014 update: a report from the American 18. Centers for Disease Control and Prevention. Current cigarette Heart Association. Circulation. 2014;129:e28-e292. smoking among adults—United States, 2011. MMWR Morb 2. Centers for Disease Control and Prevention. Vital signs: Mortal Wkly Rep. 2012;61:889-894. awareness and treatment of uncontrolled hypertension among 19. Brooks JH, Ferro A. The physician’s role in prescribing adults—United States, 2003-2010. MMWR Morb Mortal physical activity for the prevention and treatment of essential Wkly Rep. 2012;61:703-709. hypertension. JRSM Cardiovasc Dis. 2012;1(4). doi:10.1258/ 3. Centers for Disease Control and Prevention. Prevalence of cvd.2012.012012. hypertension and controlled hypertension—United States, 20. Hung OY, Keenan NL, Fang J. Physicians’ health habits are 2005 and 2008. MMWR Morb Mortal Wkly Rep. 2011;60: associated with lifestyle counseling for hypertensive patients. 94-97. Am J Hypertens. 2013;26:201-208. 4. American Heart Association. Understand your risk for high 21. Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud blood pressure. http://www.heart.org/HEARTORG/Conditions/ F. Physicians’ attitudes towards prevention: importance of HighBloodPressure/UnderstandYourRiskforHighBlood intervention-specific barriers and physicians’ health habits. Pressure/Understand-Your-Risk-for-High-Blood-Pressure_ Fam Pract. 2000;17:535-540. UCM_002052_Article.jsp. Accessed January 9, 2015. 22. Mosca L, Linfante AH, Benjamin EJ, et al. National study of 5. Chobanian AV, Bakris GL, Black HR, et al. The seventh report physician awareness and adherence to cardiovascular disease of the Joint National Committee on Prevention, Detection, prevention guidelines. Circulation. 2005;111:499-510. Evaluation, and Treatment of High Blood Pressure: the JNC 7 23. Hyman DJ, Pavlik VN. Self-reported hypertension treatment report. JAMA. 2003;289:2560-2572. practices among primary care physicians: blood pressure thresh- 6. Shi L. The impact of primary care: a focused review. olds, drug choices, and the role of guidelines and evidence- Scientifica. 2012;2012:432892. based medicine. Arch Intern Med. 2000;160:2281-2286. 7. Hing E, Uddin S. Visits to primary care delivery sites: United 24. Tai-Seale M, McGuire TG, Zhang W. Time allocation in pri- States, 2008 (NCHS Data Brief No. 47). Hyattsville, MD: mary care office visits. Health Serv Res. 2007;42:1871-1894. National Center for Health Statistics; 2010. 25. Mitchell P, Wynia M, Golden R, et al. Core principles & val- 8. Viera AJ, Cohen LW, Mitchell CM, Sloane PD. High blood ues of effective team-based health care (Discussion Paper). pressure knowledge among primary care patients with known Washington, DC: Institute of Medicine; 2012. http://www. hypertension: A North Carolina Family Medicine Research iom.edu/~/media/Files/Perspectives-Files/2012/Discussion- Network (NC-FM-RN) study. J Am Board Fam Med. Papers/VSRT-Team-Based-Care-Principles-Values.pdf. 2008;21:300-308. Accessed January 9, 2015. 9. Kreuter MW, Chheda SG, Bull FC. How does physician 26. Centers for Disease Control and Prevention. CDC grand advice influence patient behavior? Evidence for a priming rounds: the Million Hearts initiative. MMWR Morb Mortal effect. Arch Fam Med. 2000;9:426-433. Wkly Rep. 2012;61:1017-1021. 10. Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: Author Biographies cluster randomised controlled trial. BMJ. 2003;326:793. 11. Grandes G, Sanchez A, Sanchez-Pinilla RO, et al; PEPAF Jing Fang has been with CDC for 9+ years as an epidemiologist Group. Effectiveness of physical activity advice and prescrip- in the Division for Heart Disease and Stroke Prevention. Before tion by physicians in routine primary care: a cluster random- that, she was associate professor at Department of Epidemiology ized trial. Arch Intern Med. 2009;169:694-701. and Population Health at Albert Einstein College of Medicine. 12. Han JL. Actions to control hypertension among adults in Carma Ayala is a commissioned corps officer with the United Oklahoma. Prev Chronic Dis. 2011;8:A10. States Public Health Service assigned, as senior research scientist 13. Centers for Disease Control and Prevention. State-specific for 15+ years, to CDC, NCCDPHP, Division for Heart Disease trends in fruit and vegetable consumption among adults— and Stroke Prevention. She previously served as associate research United States, 2000-2009. MMWR Morb Mortal Wkly Rep. director with Texas Institute of Reproductive Medicine and 2010;59:1125-1130. Endocrinology in Houston Texas and associate research professor 14. Cogswell ME, Zhang Z, Carriquiry AL, et al. Sodium and at University of Texas Health Science Center at Houston, School potassium intakes among US adults: NHANES 2003-2008. of Public Health. Am J Clin Nutr. 2012;96:647-657. 15. Yang Q, Cogswell ME, Flanders WD, et al. Trends in cardio- Fleetwood Loustalot, PhD, FNP is the lead for the Epidemiology, vascular health metrics and associations with all-cause and Surveillance and Health Services Team in the Division for Heart CVD mortality among US adults. JAMA. 2012;307:1273- Disease and Stroke Prevention at the Centers for Disease Control and Prevention (CDC). Prior to his time with the CDC, 16. Centers for Disease Control and Prevention. Vital signs: Dr. Loustalot was in clinical practice, serving in diverse educa- binge drinking prevalence, frequency, and intensity among tional, training and clinical roles. Dr. Loustalot is a commissioned adults—United States, 2010. MMWR Morb Mortal Wkly Rep. officer in the US Public Health Service and holds the rank of 2012;61:14-19. commander. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Primary Care & Community Health SAGE

Primary Care Providers’ Recommendations for Hypertension Prevention, DocStyles Survey, 2012:

Download PDF
7 pages

Loading next page...
 
/lp/sage/primary-care-providers-recommendations-for-hypertension-prevention-WthpQKlrc8

References (27)

Publisher
SAGE
Copyright
Copyright © 2022 by SAGE Publications Inc unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses
ISSN
2150-1319
eISSN
2150-1327
DOI
10.1177/2150131915568997
Publisher site
See Article on Publisher Site

Abstract

Background: Healthy behaviors, including maintaining an ideal body weight, eating a healthy diet, being physically active, limiting alcohol intake, and not smoking, can help prevent hypertension. The objective of this study was to determine the prevalence of recommending these behaviors to patients by primary care providers (PCPs) and to assess what PCP characteristics, if any, were associated with making the recommendations. Methods: DocStyles 2012, a Web-based panel survey, was used to assess PCPs’ demographic characteristics, health-related behaviors, practice setting, and prevalence of making selected recommendations to prevent hypertension. Logistic regression was used to calculate the odds of making all 6 recommendations, by demographic, professional, or personal health behavior characteristics. Results: Overall, 1253 PCPs responded to the survey (537 family physicians, 464 internists, and 252 nurse practitioners). To prevent hypertension, 89.4% recommended a healthy diet, 89.9% recommended lower salt intake, 90.3% recommended maintaining a healthy weight, 69.4% recommended limiting alcohol intake, 95.1% recommended being physically active, and 90.4% recommended smoking cessation for their patients who smoked. More than half (56.1%) of PCPs recommended all 6 healthy behaviors. PCPs’ demographic characteristics and practice setting were not associated with recommending all 6. PCPs who reported participating in regular physical activity (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.05-2.67) and eating healthy diet (OR 1.68, 95% CI 1.11-2.56) were more likely to offer all 6 healthy behavior recommendations than those without these behaviors. Conclusion: Most PCPs recommended healthy behaviors to their adult patients to prevent hypertension. PCPs’ own healthy behaviors were associated with their recommendations. Preventing hypertension is a multifactorial effort, and in the clinical environment, PCPs have frequent opportunities to model and promote healthy lifestyles to their patients. Keywords primary care providers, hypertension (high blood pressure), prevention, healthy behaviors 10-12 motivate patients to adopt healthy behaviors. We sought Background to assess the prevalence of PCPs’ recommendations to pre- Cardiovascular disease is the leading cause of death in the vent hypertension and the factors that influence them to United States, and hypertension is a primary contributing make such recommendations. 1-3 factor. Risk factors for hypertension are well known and include modifiable behaviors (eg, physical inactivity, Methods unhealthy diet, overweight and obesity, excess alcohol consumption, smoking) and nonmodifiable factors (eg, DocStyles is a Web-based panel survey conducted by Porter family history of hypertension, age, gender, race/ethnicity). Novelli. The survey participants were family and general Current guidelines for the primary prevention of hyperten- physicians, internists, and nurse practitioners. In 2012, sion target modifiable risk behaviors. The most common places clinical care services are provided are primary care National Center for Chronic Disease Prevention and Health Promotion, provider (PCP) offices. In the United States, PCP visits Centers for Disease Control and Prevention, Atlanta, GA, USA account for more than half of all ambulatory care visits. For Corresponding Author: example, 62% of the 1.1 billion ambulatory visits were made Jing Fang, Division for Heart Disease and Stroke Prevention, National to primary care sites in 2008. This frequent interaction of Center for Chronic Disease Prevention and Health Promotion, Centers patients and PCPs creates ongoing opportunities to promote for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-72, the prevention of hypertension to a large population. Advice Atlanta, GA 30341, USA. 8,9 from PCPs has been shown to influence behaviors and to Email: [email protected] Fang et al 171 DocStyles was conducted from June to July, and participants analysis of variance tests for continuous variables. The were eligible if they had been in clinical practice for a mini- association of PCPs’ demographic characteristics and their mum of 3 years; worked at an individual, group, or hospital recommendations for hypertension prevention were practice in the United States; and saw at least 10 patients per assessed with chi-square tests. The odds of providing all 6 week. Physicians and nurse practitioners were selected from healthy behavior recommendations, adjusting for demo- separate volunteer panels. Physicians were randomly selected graphic characteristics (age, sex, race/ethnicity) and spe- from the Epocrates Honors Panel (n ≥ 275 000) and matched cialty, were assessed by logistic regression models. Other to the American Medical Association master file proportions variables (eg, physical activity, fruit or vegetable intake, for age, sex, and region. Nurse practitioners were randomly years in practice, practice setting) were added into the mod- selected from the Epocrates’ Allied Health Panel (n ≥ 78 000). els if the P was less than .2 in univariate analysis. All analy- Quotas were set to reach 1000 PCPs and 250 nurse practitio- ses were conducted using SAS software (version 9.3, SAS ners. Physicians and nurse practitioners from both panels Institute, Inc, Cary, NC). were invited to participate by e-mail. Participation was vol- untary, and respondents could exit the survey at any time. Results Those who completed the survey received an honorarium of $20 to $85, which varied depending on the skip patterns and A total of 1253 PCPs completed the survey (537 family length of the survey. The overall response rates were calcu- physicians, 464 internists, and 252 nurse practitioners). The lated using a formula that included total sample contacted, response rate was 52.2% (physicians = 49.9%, nurse practi- surveys completed, incomplete surveys, respondents not tioners = 65.4%). We found significant differences by PCP meeting screening criteria, nonresponse, and respondents specialty for demographic characteristics (gender, race/eth- removed from the eligible sample because quotas were filled. nicity), adequate fruit and vegetable consumption, and The survey asked about PCPs’ demographic characteris- practice characteristics (years in practice and practice set- tics (age, sex, race/ethnicity) and medical practice (spe- ting) (Table 1). cialty, setting, years in practice, teaching hospital privileges, A high percentage of PCPs recommended most hyperten- financial situation of the majority of their patients). sion prevention measures (Table 2). Overall, 89.4% recom- Questions about health-related behaviors included fruit or mended eating a healthy diet, 89.9% recommended reducing vegetable consumption (days per week consuming ≥5 cups salt intake, 90.3% recommended attaining or maintaining a of fruits or vegetables), current smoking (days per week healthy weight, 95.1% recommended physical activity, and smoking cigarettes, cigars, or pipes), and physical activity 90.4% recommended smoking cessation to their patients (days per week doing ≥30 minutes of physical activity). who smoked. However, only 69.4% recommended limiting Respondents also reported height and weight, which were alcohol intake. In general, the prevalence of recommending used to calculate body mass index (units of kg/m ). these behaviors was higher among PCPs who were older, Primary care providers’ hypertension prevention recom- classified as a nurse practitioner, who reported adequate fruit mendations were assessed with the question, “What types or vegetable intake, and who did not smoke. of advice do you give adult patients about preventing high Overall, 56.1% of PCPs reported that they made all 6 blood pressure?” Available responses were “Eat a healthy hypertension prevention recommendations. After adjust- diet,” “Cut down on salt,” “Attain or maintain a healthy ment, there were no significant differences in making all 6 weight,” “Get enough sleep each night,” “Limit the use of recommendations by PCP age, sex, race/ethnicity, body alcohol,” “Be physically active,” “Smoking cessation,” mass index, smoking status, specialty, or practice setting. “Take nutritional supplements,” “Try relaxation methods,” However, making all 6 recommendations was more likely “Get intellectual stimulation,” and “None of these.” among PCPs who reported consuming the recommended amount of fruits or vegetables and among those who engaged in the recommended amount of physical activity Statistical Analyses compared with those who did not (Table 3). Recommendations in agreement with current guidelines for hypertension prevention were selected for analysis: eat Discussion healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use, be physically active, and smoking The principal findings of current study is that most PCPs, cessation. We measured the prevalence of PCPs’ reported according to their self-reported statement, provided evi- hypertension prevention recommendations independently and denced-based hypertension prevention recommendations to collectively (ie, all 6 healthy behavior recommendations). their adult patients that align with current guidelines: eating The differences in PCP characteristics by specialty (fam- a healthy diet, reducing dietary salt intake, attaining or ily physician, internist, and nurse practitioner) were maintaining a healthy weight, being physically active, and assessed with chi-square tests for categorical variables and quitting smoking (for their patients who smoke). However, 172 Journal of Primary Care & Community Health 6(3) Table 1. Demographic Characteristics, Health Behaviors, and Practice Characteristics of Respondents to the DocStyles 2012 Survey, by Primary Care Physician Specialty. Overall Family Physicians Internist Nurse Practitioner PCP Characteristic (N = 1253) (n = 537) (n = 464) (n = 252) P Mean age, y (SE) 47.0 (0.27) 46.7 (0.40) 46.5 (0.46) 48.5 (0.60) .022 Gender, % Male 59.5 70.0 72.6 12.7 <.001 Female 40.5 30.0 27.4 87.3 Race/ethnicity, % Non-Hispanic white 72.9 76.7 58.2 92.1 <.001 Non-Hispanic black 3.4 3.4 4.3 2.0 Non-Hispanic other 19.4 14.5 33.4 4.0 Hispanic 4.3 5.4 4.1 2.0 Body mass index (kg/m ), % .090 Normal (<25.0) 46.9 43.9 51.3 45.2 Overweight (25.0-29.9) 40.5 42.0 38.8 40.1 Obese (≥30.0) 12.6 14.1 9.9 14.7 ≥5 cups fruits or vegetables (days/week), % 0 10.1 11.0 10.1 7.9 .029 1-4 48.8 51.0 49.8 42.1 5-7 41.2 38.0 40.1 50.0 Smoking (days/week), % 0 95.5 96.1 94.4 96.4 .322 ≥1 4.5 3.9 5.6 3.6 ≥30 minutes physical activity (days/week), % 0 8.4 7.6 8.8 9.1 .575 1-4 62.7 63.0 64.5 59.1 5-7 28.9 29.4 26.7 31.8 Mean years in practice (SE) 15.5 (0.24) 15.8 (0.37) 16.0 (0.39) 13.6 (0.4) <.001 Main practice setting, % Individual practice 17.6 19.6 15.7 16.7 <.001 Group practice 73.3 78.2 64.0 79.8 Hospital or clinic 9.2 2.2 20.3 3.6 Has privileges at teaching 42.1 40.6 52.6 25.8 <.001 hospital, % Financial situation of majority of patients, % Poor to lower middle class 19.6 20.1 17.2 22.6 .076 Middle class 39.1 42.1 37.1 36.4 Upper middle class to affluent 41.3 37.8 45.7 40.9 Abbreviations: PCP, primary care provider; SE, standard error. Chi-square test or F test for differences in distributions by practice type. By PCP report. only 69.4% of PCPs recommended limiting alcohol intake consumption, physical inactivity, and smoking. National to prevent hypertension. Overall, 56.1% of PCPs said they health data have shown considerable room for improvement recommended all 6 healthy behaviors to reduce the risk of in these lifestyle behaviors and conditions. For example, hypertension for their adult patients. Furthermore, we found only 32.5% of US adults were consuming the recommended that PCPs who consumed the recommended amount of amount of fruits or vegetables in 2000-2009, less than fruits or vegetables and participated in the recommended 10% consumed <2300 mg sodium per day in 2003-2008, amount of physical activity were significantly more likely only 32.5% of adults were with classified as normal weight to recommend all 6 healthy behaviors. in 2005-2010, binge drinking prevalence was 17.1% in Hypertension prevention recommendations recognize a 2010, 20.6% of adults met both aerobic and muscle- number of modifiable risk factors, including an unhealthy strengthening physical activity guidelines in 2011, and diet, excess sodium intake, obesity, excess alcohol about 19.0% were current smokers in 2011. Fang et al 173 Table 2. Prevalence of Making Select Hypertension Prevention Recommendations Among Respondents to the DocStyles 2012 Survey, by Primary Care Provider (PCP) Characteristics. Smoking Cessation Healthy Reduce Salt Attain Healthy Limit Alcohol Be Physically for Patients Who PCP Characteristic Diet, % Intake, % Weight, % Use, % Active, % Smoke, % Total 89.4 89.9 90.3 69.4 95.1 90.4 Mean age, y a a a <45 88.7 89.1 87.2 65.7 93.4 89.8 ≥45 89.9 90.5 92.9 72.6 96.5 91.0 Gender a a Male 88.7 89.8 88.6 71.1 94.5 88.7 Female 90.4 90.0 92.7 67.0 95.9 92.9 Race/ethnicity a a Non-Hispanic white 89.5 88.2 91.6 68.8 96.0 90.2 Non-Hispanic black 95.4 100.0 90.7 69.8 100.0 97.7 Non-Hispanic other 88.1 93.4 86.4 70.0 91.4 89.3 Hispanic 88.7 94.3 84.9 77.4 92.5 94.3 Specialty a a a a Family physicians 90.5 88.6 90.9 71.9 95.9 93.1 Internist 86.2 92.0 87.5 67.7 92.9 85.1 Nurse practitioner 92.9 88.5 94.1 67.5 97.2 94.4 Body mass index, kg/m Normal (<25.0) 89.3 90.0 90.1 68.0 94.9 91.2 Overweight (25.0-29.9) 89.4 90.3 90.1 71.8 95.3 89.2 Obese (≥30.0) 89.9 88.0 91.1 67.1 94.9 91.8 ≥5 cups fruits or vegetables, days/week a a a 0 84.1 83.3 88.1 57.2 95.2 86.5 1-4 89.7 90.5 88.5 68.7 94.8 90.8 5-7 90.3 90.7 92.8 73.3 95.4 90.9 Smoking, days/week a a a a a 0 90.0 90.6 91.1 69.6 95.7 90.9 ≥1 76.8 73.2 71.4 66,1 80.4 80.4 ≥30 minutes physical activity, days/week 0 85.7 89.5 84.8 61.9 96.2 85.7 1-4 89.8 90.2 89.7 66.4 95.2 91.0 5-7 89.5 89.2 93.1 78.2 94.5 90.6 Years in practice <5 91.0 86.6 95.5 73.1 95.5 92.5 5-10 89.4 89.2 88.6 66.1 92.7 90.0 11-20 89.6 91.3 89.0 71.1 95.1 90.7 >20 88.7 89.3 92.8 69.9 97.4 90.2 Main practice setting Individual practice 90.5 90.9 90.9 71.8 94.6 92.7 Group practice 89.5 89.9 90.5 69.3 95.5 90.2 Hospital or clinic 86.1 87.8 87.0 66.1 92.2 87.8 Privileges at teaching hospital Yes 89.4 89.4 89.9 70.6 95.1 90.7 No 89.4 90.2 90.5 68.6 95.0 90.2 Financial situation of majority of patients Poor to lower middle class 88.2 90.6 91.8 67.3 94.7 90.6 Middle class 90.2 88.2 89.0 68.0 94.7 90.0 Upper middle class to affluent 89.2 91.1 90.8 71.8 95.6 90.7 Abbreviation: PCP, primary care provider. P < .05 using chi-square test comparing differences in recommending the activity. By PCP report. 174 Journal of Primary Care & Community Health 6(3) Table 3. Prevalence and Odd Ratios of Making All 6 Healthy Behavior Recommendations, Among Respondents to the DocStyles 2012 Survey, by Primary Care Provider Characteristics. PCP Characteristic Prevalence, % P OR (95% CI) P Age, y <45 53.6 .0926 1.00 ≥45 58.3 1.23 (0.97-1.56) .084 Gender Male 56.1 .999 1.12 (0.86-1.46) .398 Female 56.1 1.00 Race/ethnicity Non-Hispanic white 55.3 .590 0.85 (0.48-1.52) .583 Non-Hispanic black 65.1 1.64 (0.70-3.83) .257 Non-Hispanic other 57.6 1.12 (0.60-2.08) .724 Hispanics 56.6 1.00 Specialty Family physician 59.0 .054 0.99 (0.70-1.39) .935 Internist 51.7 0.70 (0.49-1.02) .060 Nurse practitioner 57.9 1.00 Body mass index, kg/m Normal (<25.0) 54.8 .664 Overweight (25-29.9) 57.2 Obese (≥30.0) 57.6 ≥5 cups fruits or vegetables, days/week 0 43.7 .006 1.00 1-4 55.8 1.59 (1.06-2.38) .024 5-7 59.5 1.68 (1.11-2.56) .015 Smoking, days/week 0 56.6 .077 1.68 (0.97-2.92) .064 ≥1 46.5 1.00 ≥30 minutes physical activity, days/week 0 48.6 <.001 1.00 1-4 53.4 1.13 (0.74-1.73) .571 5-7 64.9 1.68 (1.05-2.67) .030 Years in practice medicine <5 61.2 .590 5-10 55.6 11-20 57.5 >20 53.8 Main practice setting Individual practice 59.6 .341 Group practice 55.9 Hospital or clinic 51.3 Privileges at teaching hospital Yes 55.8 .847 No 56.3 Financial situation of majority of patients Poor to lower middle class 55.1 .288 Middle class 53.9 Upper middle class to affluent 58.7 Abbreviations: PCP, primary care provider; OR, odds ratio; CI, confidence interval. Eating a healthy diet, reducing salt intake, maintaining healthy weight, limiting alcohol use, being physically active, smoking cessation. Variables not included in the model (eg, body mass index, years in practice medicine, main practice setting, privileges at teaching hospital, financial situation of majority of patients) because their P value >.2 in univariate analysis. By PCP report. Fang et al 175 Primary care providers can influence patients’ decisions provide all 6 healthy behavior recommendations for to participate in healthy lifestyle behaviors. A randomized hypertension prevention to their adult patients. Ideally, controlled trial showed that patients who received counsel- each of the recommendations would be provided to ing on physical activity from general practitioners or family patients regularly, especially those at the highest risk, but physicians increased their level of physical activity signifi- PCPs are constantly faced with clinical time constraints cantly compared with those who did not receive counsel- and patients who have multiple comorbid conditions or 10,11 24 ing. A complementary study found that patients who urgent care needs. Alternate channels for hypertension received advice from their provider to quit smoking or exer- prevention recommendations are available. For example, cise more were more likely to report that they attempted team-based care, or the use of multidisciplinary profes- these actions. The study also showed that health care pro- sionals, inside and outside the clinical setting, has been vider’s advice on physical activity was the most effective used to promote health and manage health conditions. way to improve patients’ physical activity. The health care This structure is ideally suited for prevention messages, providers can maximize the success of increasing patients’ especially those for common serious conditions such as 19 25 physical activity level by repetition of the message. hypertension. We found that PCPs’ healthy behaviors, such as getting In 2011, the US Department of Health and Human the recommended amount of physical activity and consum- Services launched the Million Hearts initiative. By bringing ing the recommended amount of fruits or vegetables, were communities, health systems, nonprofit organizations, fed- associated with recommending behaviors to prevent high eral agencies, and private sector partners together, Million blood pressure, regardless of PCP demographic and clinical Hearts focuses on implementing evidence-based strategies practice characteristics. This report is consistent with an in the clinical and community environments to collectively earlier report that PCPs’ healthy behaviors are related to prevent 1 million heart attacks and strokes over a 5-year their recommendations for healthy lifestyle behavior man- period (2012-2017). Preventing and controlling hyperten- agement among patients with hypertension. Other studies sion is essential to achieving this objective, and requires a have also found that health care providers with healthier diverse range of activities, from changing the context and lifestyle behaviors were more likely to counsel patients to supports for a healthy lifestyle to individual interventions in stop smoking, exercise, manage their weight, and reduce the clinical setting. In each of these settings, evidence-based 21-23 their alcohol intake. interventions should be used when available. Resources Our results should be interpreted in the context of poten- such as the Guide for Community Preventive Services tial selection and reporting biases. First, this report was to (http://www.thecommunityguide.org) and the US Preventive assess the intent of the health care provider, rather than to Services Task Force (http://www.uspreventiveservices assess the actual advice provided to patients. What the taskforce.org) recommendations are available for practitio- health care providers said they did could be different from ners in diverse settings. what they really did. The social desirability of saying “Yes” In the clinical setting, PCPs are a trusted source of health (i.e., that they did make these recommendations) would information who interact with the general population. We overestimate the percentage reported compared with what found that PCPs were more likely to recommend healthy actually happened in clinical practice. Second, the survey lifestyle behaviors if they themselves participated in healthy only asked about recommendations in general. Thus, it is behaviors. Hypertension prevention is multifactorial and not clear how often PCPs made the recommendations, or will require coordinated care and programs in the clinical with what degree of enthusiasm, or if the advice varied by setting coupled with effective community-based supports comorbid conditions. To assess whether and how the PCPs for healthy behaviors. made the recommendations, we would need to use a combi- Authors’ Note nation of medical chart review and clinician reports. Third, the survey was not a nationally representative sample of The findings and conclusions in this report are those of the authors physicians or nurse practitioners, and thus the results may and do not necessarily represent the official position of the Centers for Disease Control and Prevention. not be generalizable. Finally, as a Web-based survey, the survey requires internet access and a basic familiarity with Declaration of Conflicting Interests internet-based surveys. While limitations do exist when using this survey platform, DocStyles is a large, national The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this survey conducted annually among a diverse group of PCPs, article. and allows for the collection of current information on health care provider attitudes and behaviors. Funding In this study, most PCPs stated that they provided evi- denced-based hypertension prevention recommendations The author(s) received no financial support for the research, to their patients, and just more than half stated that they authorship, and/or publication of this article. 176 Journal of Primary Care & Community Health 6(3) References 17. Centers for Disease Control and Prevention. Adult participation in aerobic and muscle-strengthening physical activities—United 1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and States, 2011. MMWR Morb Mortal Wkly Rep. 2013;62:326-330. stroke statistics—2014 update: a report from the American 18. Centers for Disease Control and Prevention. Current cigarette Heart Association. Circulation. 2014;129:e28-e292. smoking among adults—United States, 2011. MMWR Morb 2. Centers for Disease Control and Prevention. Vital signs: Mortal Wkly Rep. 2012;61:889-894. awareness and treatment of uncontrolled hypertension among 19. Brooks JH, Ferro A. The physician’s role in prescribing adults—United States, 2003-2010. MMWR Morb Mortal physical activity for the prevention and treatment of essential Wkly Rep. 2012;61:703-709. hypertension. JRSM Cardiovasc Dis. 2012;1(4). doi:10.1258/ 3. Centers for Disease Control and Prevention. Prevalence of cvd.2012.012012. hypertension and controlled hypertension—United States, 20. Hung OY, Keenan NL, Fang J. Physicians’ health habits are 2005 and 2008. MMWR Morb Mortal Wkly Rep. 2011;60: associated with lifestyle counseling for hypertensive patients. 94-97. Am J Hypertens. 2013;26:201-208. 4. American Heart Association. Understand your risk for high 21. Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud blood pressure. http://www.heart.org/HEARTORG/Conditions/ F. Physicians’ attitudes towards prevention: importance of HighBloodPressure/UnderstandYourRiskforHighBlood intervention-specific barriers and physicians’ health habits. Pressure/Understand-Your-Risk-for-High-Blood-Pressure_ Fam Pract. 2000;17:535-540. UCM_002052_Article.jsp. Accessed January 9, 2015. 22. Mosca L, Linfante AH, Benjamin EJ, et al. National study of 5. Chobanian AV, Bakris GL, Black HR, et al. The seventh report physician awareness and adherence to cardiovascular disease of the Joint National Committee on Prevention, Detection, prevention guidelines. Circulation. 2005;111:499-510. Evaluation, and Treatment of High Blood Pressure: the JNC 7 23. Hyman DJ, Pavlik VN. Self-reported hypertension treatment report. JAMA. 2003;289:2560-2572. practices among primary care physicians: blood pressure thresh- 6. Shi L. The impact of primary care: a focused review. olds, drug choices, and the role of guidelines and evidence- Scientifica. 2012;2012:432892. based medicine. Arch Intern Med. 2000;160:2281-2286. 7. Hing E, Uddin S. Visits to primary care delivery sites: United 24. Tai-Seale M, McGuire TG, Zhang W. Time allocation in pri- States, 2008 (NCHS Data Brief No. 47). Hyattsville, MD: mary care office visits. Health Serv Res. 2007;42:1871-1894. National Center for Health Statistics; 2010. 25. Mitchell P, Wynia M, Golden R, et al. Core principles & val- 8. Viera AJ, Cohen LW, Mitchell CM, Sloane PD. High blood ues of effective team-based health care (Discussion Paper). pressure knowledge among primary care patients with known Washington, DC: Institute of Medicine; 2012. http://www. hypertension: A North Carolina Family Medicine Research iom.edu/~/media/Files/Perspectives-Files/2012/Discussion- Network (NC-FM-RN) study. J Am Board Fam Med. Papers/VSRT-Team-Based-Care-Principles-Values.pdf. 2008;21:300-308. Accessed January 9, 2015. 9. Kreuter MW, Chheda SG, Bull FC. How does physician 26. Centers for Disease Control and Prevention. CDC grand advice influence patient behavior? Evidence for a priming rounds: the Million Hearts initiative. MMWR Morb Mortal effect. Arch Fam Med. 2000;9:426-433. Wkly Rep. 2012;61:1017-1021. 10. Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: Author Biographies cluster randomised controlled trial. BMJ. 2003;326:793. 11. Grandes G, Sanchez A, Sanchez-Pinilla RO, et al; PEPAF Jing Fang has been with CDC for 9+ years as an epidemiologist Group. Effectiveness of physical activity advice and prescrip- in the Division for Heart Disease and Stroke Prevention. Before tion by physicians in routine primary care: a cluster random- that, she was associate professor at Department of Epidemiology ized trial. Arch Intern Med. 2009;169:694-701. and Population Health at Albert Einstein College of Medicine. 12. Han JL. Actions to control hypertension among adults in Carma Ayala is a commissioned corps officer with the United Oklahoma. Prev Chronic Dis. 2011;8:A10. States Public Health Service assigned, as senior research scientist 13. Centers for Disease Control and Prevention. State-specific for 15+ years, to CDC, NCCDPHP, Division for Heart Disease trends in fruit and vegetable consumption among adults— and Stroke Prevention. She previously served as associate research United States, 2000-2009. MMWR Morb Mortal Wkly Rep. director with Texas Institute of Reproductive Medicine and 2010;59:1125-1130. Endocrinology in Houston Texas and associate research professor 14. Cogswell ME, Zhang Z, Carriquiry AL, et al. Sodium and at University of Texas Health Science Center at Houston, School potassium intakes among US adults: NHANES 2003-2008. of Public Health. Am J Clin Nutr. 2012;96:647-657. 15. Yang Q, Cogswell ME, Flanders WD, et al. Trends in cardio- Fleetwood Loustalot, PhD, FNP is the lead for the Epidemiology, vascular health metrics and associations with all-cause and Surveillance and Health Services Team in the Division for Heart CVD mortality among US adults. JAMA. 2012;307:1273- Disease and Stroke Prevention at the Centers for Disease Control and Prevention (CDC). Prior to his time with the CDC, 16. Centers for Disease Control and Prevention. Vital signs: Dr. Loustalot was in clinical practice, serving in diverse educa- binge drinking prevalence, frequency, and intensity among tional, training and clinical roles. Dr. Loustalot is a commissioned adults—United States, 2010. MMWR Morb Mortal Wkly Rep. officer in the US Public Health Service and holds the rank of 2012;61:14-19. commander.

Journal

Journal of Primary Care & Community Health – SAGE

Published: Feb 4, 2015

Keywords: primary care providers; hypertension (high blood pressure); prevention; healthy behaviors

There are no references for this article.