Factors influencing U.S. physicians' decision to provide behavioral counseling

Prevention and treatment of non-communicable diseases is critical due to high costs of healthcare and increasing prevalence. Historical trends suggest physicians underperform in behavioral counseling (including exercise, diet/nutrition, or weight management). This study investigated physicians' decision-making by examining non-clinical sociological factors that influence ordering and provision of behavioral counseling. This was a retrospective multi-year cross-sectional study. Using the Eisenberg model of physician-decision making, we analyzed data from the 2005-2015 National Ambulatory Medical Care Surveys (unweighted N = 177,599). Four weighted logistic regressions were performed to examine sociological factors associated with physician prescribing or ordering of behavioral counseling. Behavioral counseling was provided at suboptimal rates. Patient age, race/ethnicity, body weight status, and reasons for a medical visit were associated with physicians' decision to provide or order behavioral counseling. There was in general a decreasing trend of odds of provision of behavior counseling from 2005 to 2015. Patients who had been seen before were more likely to receive diet/nutrition and exercise counseling. This study concluded that ordering and provision of behavioral counseling was less than optimal. Policy makers and educators can consider factors that influence physicians' decisions for behavioral counseling to improve training and site policies. Future research examining effective behavioral counseling training and strategies to promote its provision, in particular to patients of different races/ethnicities and with different medical conditions, may increase effectiveness. Integrated care with behavioral health professionals could improve rates and/or delivery of counseling. Physicians can consider providing behavioral counseling when patients present with new problems and to newly seen patients.