Kottke T E, Foels J K, Hill C, Choi T, Fenderson D A
Prev Med. 1984 Mar;13(2):219-25. doi: 10.1016/0091-7435(84)90053-7.
A community approach to cardiovascular disease control is advocated for the United States because of the high disease incidence and prevalence relative to other countries. The goal of this approach is to change nutrition behavior of all members of the community. As part of a program to identify barriers to physician participation, a survey of a random sample of family practice clinical faculty in a midwestern state was made to determine (a) if physicians agree that it is appropriate to give nutritional advice to a patient who came to the clinic for another reason, (b) the proportion of patients given nutritional advice, and (c) the barriers to giving nutritional advice. Most physicians report that giving nutritional advice to patients visiting them for other reasons is considered appropriate, but almost half the physicians give advice about dietary fat, dietary sodium, or dietary fiber to fewer than 20% of their patients. Only about 10% of physicians give advice to more than 80% of their patients. Absence of elevated risk factor levels or nutritional disease is the most common reason for not giving advice. Perceived lack of patient interest and expectation of patient nonadherence are also barriers. Unpalatability of the diet is occasionally a barrier. Cost of the diet is not a consideration. From these data it is concluded that family physicians consider it appropriate to give nutritional advice to patients who are not necessarily seeking it, but the perception that patients do not need or want, and would not follow, the advice inhibits physicians from delivering nutrition messages in private practice.
由于与其他国家相比，美国心血管疾病的发病率和患病率较高，因此提倡采用社区方法来控制心血管疾病。这种方法的目标是改变社区所有成员的营养行为。作为确定医生参与障碍的项目的一部分，对中西部一个州的家庭医疗临床教员进行了随机抽样调查，以确定：（a）医生是否同意向因其他原因前来诊所的患者提供营养建议是合适的；（b）接受营养建议的患者比例；（c）提供营养建议的障碍。大多数医生报告说，向因其他原因前来就诊的患者提供营养建议被认为是合适的，但几乎一半的医生向不到20%的患者提供有关膳食脂肪、膳食钠或膳食纤维的建议。只有约10%的医生向超过80%的患者提供建议。没有危险因素水平升高或营养疾病是不提供建议的最常见原因。认为患者缺乏兴趣以及预期患者不会依从也是障碍。饮食不可口偶尔也是一个障碍。饮食成本不是一个考虑因素。从这些数据可以得出结论，家庭医生认为向不一定寻求营养建议的患者提供营养建议是合适的，但认为患者不需要、不想要且不会遵循该建议的看法阻碍了医生在私人诊所提供营养信息。
