Barriers to Providing Nutrition Counseling Cited by Physicians

Nutrition in Clinical Practice - Tập 25 Số 5 - Trang 502-509 - 2010
Kathryn M. Kolasa1,2, Katherine Rickett1
1Brody School of Medicine at East Carolina University, Greenville, North Carolina;
2University Health Systems of Eastern Carolina, Greenville, North Carolina

Tóm tắt

In a 1995 pivotal study, Kushner described the attitudes, practice behaviors, and barriers to the delivery of nutrition counseling by primary care physicians. This article recognized nutrition and dietary counseling as key components in the delivery of preventive services by primary care physicians. Kushner called for a multifaceted approach to change physicians’ counseling practices. The prevailing belief today is that little has changed. Healthy People 2010 and the U.S. Preventive Task Force identify the need for physicians to address nutrition with patients. The 2010 objective was to increase to 75% the proportion of office visits that included ordering or providing diet counseling for patients with a diagnosis of cardiovascular disease, diabetes, or hypertension. At the midcourse review, the proportion actually declined from 42% to 40%. Primary care physicians continue to believe that providing nutrition counseling is within their realm of responsibility. Yet the gap remains between the proportion of patients who physicians believe would benefit from nutrition counseling and those who receive it from their primary care physician or are referred to dietitians and other healthcare professionals. The barriers cited in recent years continue to be those listed by Kushner: lack of time and compensation and, to a lesser extent, lack of knowledge and resources. The 2010 Surgeon General's Vision for a Healthy and Fit Nation and First Lady Obama's “Let's Move Campaign” spotlight the need for counseling adults and children on diet and physical activity.

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Tài liệu tham khảo

10.1089/obe.2009.0503

Flocke SA, 2005, Exercise, diet, and weight loss advice in the family medicine outpatient setting, Fam Med, 37, 415

10.1016/j.healthpol.2007.04.003

10.1016/j.amepre.2004.04.023

10.1331/154434506777069516

10.1093/ajcn/73.6.1006

Kolasa KM, 2006, The clinical nutritional implications of obesity and overweight, N C Med J, 67, 283

Kushner RF, 2003, Danon Institute Award for Excellence in Medical/Dental Nutrition Education Lecture, 2002. Will there be a tipping point in medical nutrition education?, Am J Clin Nutr, 77, 288

10.1001/archfami.4.7.589

10.1007/s11606-009-1042-5

Wynn K, 2010, Nutrition in primary care: current practices, attitudes, and barriers, Can Fam Physician, 56, e109

10.2105/AJPH.93.4.635

10.1016/j.ypmed.2003.09.046

10.1016/S0749-3797(18)30473-2

10.1016/S0749-3797(02)00494-4

Council on Foods and Nutrition, American Medical Association, 1963, Nutrition teaching in medical schools, JAMA, 183, 955

10.1093/ajcn/38.5.800

Committee on Nutrition in Medical Education, Food and Nutrition Board, National Research Council, 1985, Nutrition Education in U.S. Medical Schools

U.S. Preventive Services Task Force, 1989, Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force; Preface by Robert S. Lawrence

National Nutrition Monitoring and Related Research Act of 1990; Public Law 101‐455 101st Cong.

Weinsier RL, 1995, National Dairy Council Award for Excellence in Medical/Dental Nutrition Education Lecture, 1995: medical‐nutrition education—factors important for developing a successful program, Am J Clin Nutr, 62, 837, 10.1093/ajcn/62.4.837

American Academy of Family Physicians.Recommended curriculum guidelines for family medicine residents: nutrition.http://www.aafp.org/online/etc/medialib/aafp_org/documents/about/rap/curriculum/nutrition.Par.0001.File.tmp/Reprint275.pdf. Updated2008. Accessed March 15 2000.

Cooksey K, 2000, Getting nutrition education into medical schools: a computer‐based approach, Am J Clin Nutr, 72, 868S, 10.1093/ajcn/72.3.868s

Feldman EB, 1991, Educating physicians in nutrition: a view of the past, the present, and the future, Am J Clin Nutr, 54, 618, 10.1093/ajcn/54.4.618

Gershoff SN, 1996, National Dairy Council Award for Excellence in Medical/Dental Nutrition Education Lecture, 1996: nutrition education—success or failure?, Am J Clin Nutr, 64, 809, 10.1093/ajcn/64.5.809

Halsted CH, 1998, Clinical nutrition education: relevance and role models, Am J Clin Nutr, 67, 192, 10.1093/ajcn/67.2.192

10.1093/ajcn/83.4.968S

Shils ME, 1994, National Dairy Council Award for Excellence in Medical and Dental Nutrition Education Lecture, 1994: nutrition education in medical schools—the prospect before us, Am J Clin Nutr, 60, 631, 10.1093/ajcn/60.4.631

St Jeor ST, 2006, Medical nutrition: a comprehensive, school‐wide curriculum review, Am J Clin Nutr, 83, 963S, 10.1093/ajcn/83.4.963S

10.1093/ajcn/83.4.936S

10.1093/ajcn/50.4.707

10.1097/00017285-200605000-00006

Price JH, 1991, Patients’ expectations of the family physician in health promotion, Am J Prev Med, 7, 33, 10.1016/S0749-3797(18)30963-2

10.1006/pmed.1995.1087

10.1093/fampra/17.2.197

10.1001/archfami.6.2.135

Okene IS, 1997, Training physicians in cholesterol counseling benefits patients, Am Fam Physician, 55, 920

Stange KC, 1998, Illuminating the ‘black box’: a description of 4454 patient visits to 138 family physicians, J Fam Pract, 46, 377

10.1542/peds.2007-2329C

10.1016/j.jada.2009.10.042

10.1016/j.ambp.2007.07.006

Heimburger DC, 1998, Survey of clinical nutrition training programs for physicians, Am J Clin Nutr, 68, 1174, 10.1093/ajcn/68.6.1174

Kahn RF, 2006, Continuing Medical Education in nutrition, Am J Clin Nutr, 83, 981S, 10.1093/ajcn/83.4.981S

Lindell KC, 2006, Zeisel Nutrition in Medicine, a computer‐assisted curriculum, Am J Clin Nutr, 83, 956S, 10.1093/ajcn/83.4.956S

10.1177/011542650802300190

Silberberg M, 2010, IN4Kids: data from a study of RD integration into primary care

AlbrightJ ArmstrongS ChristiansonLet al.North Carolina's pediatric obesity clinician's reference guide and tool kit. Presented at: CDC Weight of the Nation Conference July 28 2009; Washington DC.

Expert Committee.Expert Committee Recommendations on the Assessment Prevention and Treatment of Child and Adolescent Overweight and Obesity—2007: An Implementation Guide.http://www.nichq.org/documents/coan‐papers‐and‐publications/COANImplementationGuide62607FINAL.pdf. Accessed March 31 2010.

Eat Smart Move More NC.http://www.eatsmartmovemorenc.com/PediatricObesityTools/PediatricObesityTools.html. Accessed March 30 2010.

10.7326/0003-4819-139-11-200312020-00012

U.S. Department of Health and Human Services.Guide to Clinical Preventive Services 2009.http://www.ahrq.gov/clinic/pocketgd09/. Accessed March 30 2010.

U.S. Department of Health and Human Services.The Surgeon General's Vision for a Healthy and Fit Nation.http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf. Updated2010. Accessed March 3 2010.

Healthy People 2010.Midcourse Review.http://www.healthypeople.gov/data/midcourse/pdf/fa19.pdf. Accessed March 31 2010.

Healthy People 2000.Nutrition Resource List.http://odphp.osophs.dhhs.gov/pubs/HP2000/2nutr2.htm. Accessed March 31 2010.

U.S. Department of Health and Human Services.The Physician Workforce: Projections and Research Into Current Issues Affecting Supply and Demand.http://bhpr.hrsa.gov/healthworkforce/reports/physicianworkforce/default.htm. Accessed March 28 2010.

10.1016/j.jada.2006.09.008

National Committee for Quality Assurance, 2008, Standards and Guidelines for Physician Practice Connections: Patient‐Centered Medical Home

Let's Move.America's Move to Raise a Healthier Generation of Kids.www.let'smove.gov. Accessed March 31 2010.