Factors associated with lifestyle counseling provided to patients with prehypertension
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Prehypertension is an increasingly common diagnosis in this country and is a predictor of a future hypertension diagnosis. Current guidelines recommend lifestyle modifications for prehypertension treatment. This study attempts to evaluate the provider, physician, and patient-related factors that affect whether physicians provide lifestyle counseling to patients with prehypertension. This study is a cross-sectional, retrospective cohort study using the 2007–2010 datasets from the National Ambulatory Medical Care Survey. The analysis sample included 2,804 patient visit records of prehypertensive patients. The outcome variable is whether any lifestyle counseling that included smoking cessation, dietary change, and/or weight loss was provided. A logistic regression model was constructed to assess the effects that patient, physician and provider characteristics had on the outcome variable. Out of the total analysis sample of 2,804, 30% of the patients received at least one form of lifestyle counseling. Patient factors that were statistically significant included: having diabetes (odds ratio (OR)=2.32, 95% confidence interval (CI), 1.70–3.17), being over-weight (OR=1.64, 95% CI: 1.25 – 2.15), being identified as smokers (OR=1.65, 95% CI: 1.19–2.29). Significant provider characteristics included solo practices (OR=0.67 95% CI: 0.50–0.90); having electronic health record system with a patient problem list feature (OR=1.46, 95% CI: 1.08–1.98), electronic reminders of clinical guidelines (OR=1.42, 95% CI: 1.03–1.96), and medical/surgical physician specialty (OR=0.67, 95% CI: 0.45–0.99). Among the financial factors, only the percent revenue from Medicaid was significant, with the 26–75% Medicaid revenue having an OR of 0.45 (95% CI: 0.29–0.71) compared with the 0–25% reference level.