Introduction:
Research demonstrates dietary modifications in post-stroke patients facilitated by nutrition consultations improve post stroke recovery and reduce risk of recurrent stroke. Racial/ethnic differences in post-stroke nutrition practices demonstrate that focused dietary counseling of minority groups may be needed. It is unknown to what extent clinicians are providing dietary counseling in ambulatory office visits.
Methods:
We used data from the 2011 to 2016 National Ambulatory Medical Care Surveys to assess trends in post-stroke diet consultations during routine office visits across all races and ethnicities. We use multivariate logistic regression models to assess variation in the provision of dietary counseling by patient and provider characteristics.
Results:
There were 4,960 patients with a history of stroke among a total of 249,282 in the study period. The proportion of patients with stroke over the age of 60 who received diet counseling increased from 6% in 2012 (95% Confidence Interval (CI)=4%, 9%) to 14% in 2016 (95% CI= 7%, 21%). Adjusted models showed that other, non-Hispanic patients had a higher likelihood of receiving diet counseling, compared with whites (Odds Ratio (OR)=1.80, 95% CI=0.85, 3.82). Patients in the South were more likely to receive diet counseling than patients from the West (OR=1.47, 95% CI=0.81, 2.67). Patients in metropolitan areas had (OR=1.84, 95% CI=1.09, 3.09) a higher likelihood of counseling compared to patients in rural areas (OR=1.84, 95% CI=1.09, 3.09). Neurologists were less likely to provide counseling when compared to family medicine physicians (OR=0.14, 95% CI=0.07, 0.28).
Conclusion:
Major gaps in post-stroke dietary counseling exist; though the proportion of Americans over 60 receiving dietary counseling in ambulatory visits has been increasing in the past half-decade. Future interventions should focus on addressing gaps in counseling.
