title: Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Nutrition Research Unit, University of Chicago, IL 60637, USA. rkushner@midway.uchicago.edu.
authors.forename: R F
authors.initials: RF
authors.lastname: Kushner
mesh_terms: D000328:Adult; D003376:Counseling / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D052756:Nutritional Sciences / Q000193:education*; D010821:Physicians, Family / Q000193:education / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D016312:Treatment Refusal; D014481:United States; D016526:Workload