Docs' Counseling Ignored
A physician's or other healthcare worker's "counseling intervention"urging lifestyle changes aimed at preventing cardiovascular disease may have no effect. "Although the correlation among healthful diet, physical activity, and the incidence of CVD is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small," wrote United States Preventive Task Force member Virginia Moyer, MD, MPH and colleagues in the Annals of Internal Medicine.
The team went on to suggest that clinicians "may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population . . . Issues to consider include other risk factors for CVD, a patient's readiness for change, social support and community resources that support behavioral change, and other health care and preventive service priorities."
The recommendations were based on studies of medium- and high-intensity behavioral counseling interventions, but not low-intensity interventions. The intensity of the interventions is categorized by total patient contact time with low being 1 to 30 minutes, medium being 31 minutes to 6 hours, and high being over 6 hours. In general, low-intensity interventions consist only of mailed materials or of 1 to 2 single, brief sessions with primary care clinicians or other trained persons. Medium-intensity interventions involve a range of 3 to 24 phone sessions or 1 to 8 in-person sessions. High-intensity interventions involve a range of 4 to 20 in-person group sessions.
Although intensive counseling doesn't appear to harm patients, spending so much time with patients to no avail amounts to a "lost opportunity to provide other services that have a greater health effect," the task force concluded.