Physician counseling for hypertension: what do doctors really do?

OBJECTIVE: To describe patient counseling by physicians on hypertension and lifestyle and assess its impact on participants' satisfaction.
METHODS: An analysis was conducted of transcripts of audio-recorded outpatient visits, augmented with patient and physician surveys. Participants were 30 primary care physicians, 11 cardiologists, and 120 hypertensive patients. Each transcript was coded into categories descriptive of physicians' counseling behaviors. Patients and physicians completed pre- and post-visit questionnaires; patients also completed a survey 2 weeks after their visit.
RESULTS: Most physicians assessed patient medication adherence, but counseling on hypertension and lifestyle was limited. Receipt of lifestyle counseling had a positive, short-lived impact on patient satisfaction. Physicians reported greater satisfaction with visits characterized by more lifestyle counseling. Amount of counseling provided was unrelated to the presence of cardiovascular comorbidities. Provision of counseling was not associated with physicians' perceptions of visit burden. Lifestyle counseling was associated with longer visits.
CONCLUSION: Hypertensive patients received relatively little information about hypertension and beneficial lifestyle changes. PRACTICE IMPLICATIONS: Office visits provide an important opportunity for physicians to reinforce key hypertension-related educational messages. Physicians could do more to underscore the importance of medication adherence and healthy living to their patients with hypertension.