Lifestyle Counseling Trends in Ambulatory Care Settings: Results from National Ambulatory Medical Care Survey (NAMCS) 公开

Abstract

Background:

The American College of Cardiology and American Heart Association 2013 (ACC/AHA) guidelines emphasized lifestyle counseling as the foundation for ASCVD prevention. We aim to examine trends in lifestyle counseling among statin users in a nationally representative, ambulatory database.

Methods:

The National Ambulatory Medical Care Survey (NAMCS) provides measures of ambulatory medical care services used in the United States. Sample consisted of patients >40 years, that were seen in ambulatory primary care clinics. We examined trends in lifestyle counseling included weight reduction, diet, exercise, and tobacco cessation in patients receiving statins from 2006-2016. Patient sample weights were applied to enable nationally representative estimates. Univariate and logistic regression analysis performed.

Results:

From 2006-2016, 42,362 total outpatient visits involved statin users in primary care visits in the US. Overall, any type of lifestyle counselling remained low at <25% in primary care settings. Diet counseling declined from 23.5% in 2006 to 20.5% in 2016, similar trends with exercise counseling (19.3% in 2006 to 15.7% in 2016). Among current smokers, 30.5% received tobacco counseling in 2006 and 32.2% in 2016. In regression analysis, no significant change was found for any lifestyle counseling post-2013 compared to years prior after adjusting for sociodemographics, comorbidities, and region. Adults 70 years and older are less likely to receive weight, diet, exercise, and tobacco counseling.

Conclusion:

Despite the ACC/AHA guidelines emphasis on lifestyle for high-risk populations, counseling rates remain low in primary care clinics. More interventions focusing on lifestyle are needed in ambulatory clinic settings for primary and secondary prevention of CVD. 

Table of Contents

Abstract……………………………………………………………………………………………………………………………4 Introduction……………………………………………………………………………………………………………………..6 Methods…………………………………………………………………………………………………………………………..8 Results……………………………………………………………………………………………………………………………10 Discussion………………………………………………………………………………………………………………………12 References……………………………………………………………………………………………………………………..16 Figures……………………………………………………………………………………………………………………………20 Supplemental…………………………………………………………………………………………………………………26

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
关键词	Lifestyle counseling NAMCS Statin ASCVD Ambulatory
Committee Chair / Thesis Advisor	Ambar Kulshreshtha, Emory University
Committee Members	Amit Shah, Emory University

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