title: Dietary counselling for cardiovascular disease prevention in primary care settings: results from a German physician survey.
abstract: BACKGROUND
  Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany.
  
  
  OBJECTIVE
  To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention.
  
  
  METHODS
  A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics.
  
  
  RESULTS
  While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition.
  
  
  CONCLUSIONS
  The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, tatiana.goerig@medma.uni-heidelberg.de.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Görig
authors.affiliation: Internistic Group Practice Dr. med. Manfred Mayer und Dr. med. Angela Schmid, Mannheim and Ärztenetz Qu@linet e.V., Mannheim, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Mayer
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim.
authors.forename: Christina
authors.initials: C
authors.lastname: Bock
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim.
authors.forename: Katharina
authors.initials: K
authors.lastname: Diehl
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hilger
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim.
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Herr
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim.
authors.forename: Sven
authors.initials: S
authors.lastname: Schneider
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003376:Counseling; D005247:Feeding Behavior; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
keywords: Cardiovascular diseases; counselling; health behaviour; physicians; prevention; primary health care.