title: [Differences in the Provision of Lifestyle Counseling for Cardiovascular Disease Prevention Between Urban and Rural Regions in Germany. Findings from a National Survey of Primary Care Physicians].
abstract: OBJECTIVE
  In Germany, shortages in primary care physicians (PCPs) were reported in some rural regions. In this paper, we explored if regional differences in the distribution of PCPs are associated with the provision of lifestyle counseling in primary care.
  
  
  METHODS
  In a nationwide study, a total of 4,074 randomly selected PCPs were asked about provision of lifestyle counseling to their patients, their attitudes, and perceived barriers.
  
  
  RESULTS
  PCPs from rural regions provided less frequently lifestyle advice for cardiovascular disease prevention. Compared to their colleagues in urban areas, more PCPs from rural regions believed that were inadequately qualified for the lifestyle counseling and that they had been less successful in helping patients to modify their lifestyles. Physicians from rural practices named more often than PCPs from urban practices a lack of adherence by the patients (65 vs. 57%), insufficient opportunities to collaborate with providers of preventive services (62 vs. 55%), and lack of time (66 vs. 52%; all p<0.001) as barriers in providing patients with lifestyle counseling.
  
  
  CONCLUSIONS
  Taking into account the expected increased shortages in PCPs in rural regions, the results show the need for targeted interventions for improving lifestyle counseling in rural practices.
authors.affiliation: Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Mannheim.
authors.forename: T
authors.initials: T
authors.lastname: Görig
authors.affiliation: Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Mannheim.
authors.forename: K
authors.initials: K
authors.lastname: Diehl
authors.affiliation: Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Mannheim.
authors.forename: R M
authors.initials: RM
authors.lastname: Herr
authors.affiliation: Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Mannheim.
authors.forename: C
authors.initials: C
authors.lastname: Bock
authors.affiliation: Internistische Gemeinschaftspraxis Dr. med. Manfred Mayer und Dr. med. Angela Schmid, Genossenschaft Gesundheitsprojekt Mannheim e.G.
authors.forename: M
authors.initials: M
authors.lastname: Mayer
authors.affiliation: Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Mannheim.
authors.forename: S
authors.initials: S
authors.lastname: Schneider
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D037001:Directive Counseling / Q000145:classification / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D040242:Risk Reduction Behavior; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data*