Physician Attitudes Regarding Cardiovascular Risk Reduction: The Gaps Between Clinical Importance, Knowledge, and Effectiveness

Abstract

Reducing risk factors for patients with vascular disease can reduce the subsequent incidence of cerebro-cardiovascular disease. While physicians have had extensive training in the importance of atherosclerotic vascular disease risk factor modification, evidence suggests that they systematically miss opportunities for clinical prevention during routine practice. The aim of this study was to identify whether physicians felt confident in their knowledge and effectiveness regarding counseling patients to reduce cardiovascular risk and to determine barriers to prevention interventions in the office setting. Surveys were mailed to 509 physicians affiliated with an academic community hospital. Nonrespondents were sent reminders and a second survey. Comparisons were made using chi-square analysis. Two hundred and five surveys were returned (40.3%). Thirty-six percent of physicians felt knowledgeable about weight management techniques, compared to 3% who were confident that they succeeded in their practice (p < 0.001). Similar patterns were found for Tobacco Cessation (62% versus 14%, p = 0.001), Alcohol Reduction (46% versus 7%, p < 0.001), Stress Management (35% versus 5%, p < 0.001), Exercise (53% versus 10%, p < 0.001), Nutrition (36% versus 8%, p < 0.001), Diabetes Management (48% versus 23%, p < 0.001), Blood Pressure Management (57% versus 43%, p < 0.001) and Lipid Management (59% versus 38%, p < 0.001). We identified a significant gap between physician confidence in their knowledge about risk factors and their effectiveness at providing counseling and obtaining results in their office. Most physicians felt that the routine office follow-up visit was an ineffective method for instituting vascular risk factor reduction. Alternate settings for risk factor reduction may be needed for improving atherosclerosis prevention.

The dilemma of patient responsibility for lifestyle change: Perceptions among primary care physicians and nurses

“…Other studies have shown that although a majority of individuals with lifestyle-related diseases are willing to alter their diet to a more healthy one, a considerable proportion are not living according to this will to do so [20]. Healthcare professionals refer to low patient compliance [21] and lack of patient interest [22,23] as barriers to disease prevention. Yet another reason behind professionals' rather negative judgements concerning their patients' willingness to change might be unrealistic and even idealistic expectations in respect of lifestyle change.…”

Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?

“…Nurses and doctors are often not motivated to deliver cessation interventions as they perceive it to be outside their roles. A survey of US physicians found that whilst the majority (62%) were confident about their knowledge of the benefits of smoking cessation, few (14%) offered it in practice [102]. High patient volume and complexity of the health issues in presenting patients are also reported as factors that limit the time available for effective smoking cessation counseling [103].…”

An Assessment of Specialist Physician Referral Practices for Long-Term Cardiovascular Risk Reduction in the Community: Are We Using Our Available Resources?

“…2,6,11 Cardiovascular risk reduction (CRR) programs address modifiable risk factors and have demonstrated appreciable reductions in morbidity and mortality from CVD. 4,6,[11][12][13][14][15] Unfortunately, Canadian physicians have limited time to counsel their patients regarding CRR. 16 The focus of doctor-patient interactions tends to prioritize diagnosis and management of established medical disease.…”