BARRIERS TO PROVIDING NUTRITION COUNSELING BY PHYSICIANS - A SURVEY OF PRIMARY-CARE PRACTITIONERS

Background. Previous surveys have shown that there is a disparity betw een physicians' beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of n utrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the deliver y of nutrition counseling by primary care physicians. Methods. A rando m-sample-mailed questionnaire was sent to 2,250 primary care physician s selected from the AMA masterfile from general practice, internal med icine, and pediatrics, representing self-employed, group, hospital, an d HMO practices. Participants were stratified by age, gender, geograph ical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patien ts receiving dietary counseling and to identify barriers to the delive ry of nutrition counseling. Results. A 49% response rate (n = 1,103) w as obtained. Results are presented for the 1,030 physicians (70% priva te practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer mi n discussing dietary changes. Despite this pattern, nearly three-quart ers of respondents feel that dietary counseling is important and is th e responsibility of the physician. Ranking of perceived barriers to de livery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling training, lack of k nowledge, inadequate reimbursement, and low physician confidence. Conc lusions. This survey suggests that multiple barriers exist that preven t the primary care practitioner from providing dietary counseling. A m ultifaceted approach will be needed to change physician counseling beh avior. (C) 1995 Academic Press, Inc.