Stress is a contributing factor to health conditions that account for at least three of every five visits to doctor offices in the U.S., and yet primary care physicians offer or recommend stress-management counseling to only 3 percent of patients, new research shows.
The study, by health specialists at Beth Israel Deaconess Medical Center in Boston, suggests many doctors are missing a tremendous opportunity to have a positive impact on the physical and mental health of their patients.
"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," said Dr. Aditi Nerurkar, a primary care physician who led the study published online in the Archives of Internal Medicine. "In fact, stress management counseling is the least common type of physician counseling, falling behind counseling for nutrition, exercise, weight loss, and smoking."
To reach their conclusions, Nerurkar and colleagues examined patient medical records from more than 34,000 office visits and 1,263 physicians taken from 2006 to 2009 as part of a study known as the National Ambulatory Medical Care Survey. They tracked evidence of doctors who provided stress management help, including counseling at the visit, providing "information intended to help patients reduce stress through exercise, biofeedback, yoga, etc.," or referrals "to other health professionals for the purpose of coping with stress."
What they found is 97 percent of the time physicians did not acknowledge stress as a factor in their patients’ health or offer stress counseling. Only the most “complex” patients, particularly those coping with depression, were offered counseling.
"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."
Dr. Russell S. Phillips, director of the Harvard Medical School Center for Primary Care and a study co-author, said the findings suggest incorporating more of a team-based approach to primary care might get patients into stress-management programs earlier and improve their overall health and wellness.
"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," he said.
The study was funded, in part, by the National Institutes of Health.