Kushner R F
Clinical Nutrition Research Unit, University of Chicago, IL 60637, USA.
Prev Med. 1995 Nov;24(6):546-52. doi: 10.1006/pmed.1995.1087.
Previous surveys have shown that there is a disparity between physicians' beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of nutrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the delivery of nutrition counseling by primary care physicians.
A random-sample-mailed questionnaire was sent to 2,250 primary care physicians selected from the AMA masterfile from general practice, internal medicine, and pediatrics, representing self-employed, group, hospital, and HMO practices. Participants were stratified by age, gender, geographical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patients receiving dietary counseling and to identify barriers to the delivery of nutrition counseling.
A 49% response rate (n = 1,103) was obtained. Results are presented for the 1,030 physicians (70% private practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer min discussing dietary changes. Despite this pattern, nearly three-quarters of respondents feel that dietary counseling is important and is the responsibility of the physician. Ranking of perceived barriers to delivery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling, training, lack of knowledge, inadequate reimbursement, and low physician confidence.
This survey suggests that multiple barriers exist that prevent the primary care practitioner from providing dietary counseling. A multifaceted approach will be needed to change physician counseling behavior.
先前的调查表明，医生对于饮食和营养在健康维护及疾病预防中的重要性的认知，与实际提供营养咨询服务之间存在差距。本研究的主要目的是评估初级保健医生目前对于提供营养咨询的态度、实践行为及障碍。
向从美国医学协会主文件中选取的2250名初级保健医生邮寄随机抽样问卷，这些医生来自全科医学、内科和儿科，代表个体执业、团体执业、医院及健康维护组织（HMO）执业情况。参与者按年龄、性别、地理区域和当前就业情况进行分层。主要结果指标是确定医生提供饮食咨询所花费的时间以及接受饮食咨询的患者百分比，并识别提供营养咨询的障碍。
获得了49%的回复率（n = 1103）。对1030名（70%为私人执业）有完整数据的医生呈现结果。超过三分之二的医生为40%或更少的患者提供饮食咨询，且花费5分钟或更少时间讨论饮食变化。尽管如此，近四分之三的受访者认为饮食咨询很重要且是医生的责任。饮食咨询交付感知障碍的排名依次为：时间不足、患者不依从、教材不足、缺乏咨询培训、知识不足、报销不足以及医生信心低。
这项调查表明存在多种障碍阻碍初级保健从业者提供饮食咨询。需要采取多方面的方法来改变医生的咨询行为。
