Stress is associated with more office visits and disease, but little is known about stress management counseling in primary care.^3,4 Our study objective was to examine the rates of stress management counseling by U.S. primary care physicians and to identify associated factors.

METHODS

We obtained data from the 2006–2009 National Ambulatory Medical Care Survey (NAMCS), a cross-sectional, multi-staged, stratified sampling survey of randomly-selected, office-based physicians in the U.S. From 2006–2009, information was available on an aggregate of 123,192 office visits to 5,105 physicians (average response rate 60.4%).⁵ We examined office visits which included stress management counseling provided by a primary care physician. Stress management was defined as “information intended to help patients reduce stress through exercise, biofeedback, yoga, etc.” and included physician counseling at the visit and “referrals to other health professionals for the purposes of coping with stress.” ⁵ Our final sample consisted of 34,065 visits to 1,263 physicians.

We conducted weighted analyses using SAS-callable SUDAAN (version 10.0; SAS Institute Inc) to account for the multi-staged probability design, clustering of patients by physician, and oversampling of selected physician practices used by NAMCS. Potential correlates of the provision of stress management counseling by primary care physicians were (1) patient demographic characteristics (age, sex, race, education, income, region, insurance status and survey year), and (2) visit characteristics (physician specialty, visit continuity, visit acuity, number of chronic conditions, number of visits, visit length and diagnosis). Multivariable logistic regression modeling identified those factors independently associated with physician counseling about stress.