PHYSICIAN-BASED DIET COUNSELING FOR CHOLESTEROL REDUCTION - CURRENT PRACTICES, DETERMINANTS, AND STRATEGIES FOR IMPROVEMENT
PHYSICIAN-BASED DIET COUNSELING FOR CHOLESTEROL REDUCTION - CURRENT PRACTICES, DETERMINANTS, AND STRATEGIES FOR IMPROVEMENT
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DOI：
10.1006/pmed.1993.1007
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发表时间：
1993-01-01
影响因子：
5.1
通讯作者：
SISCOVICK, DS
中科院分区：
文献类型：
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作者：
AMMERMAN, AS;DEVELLIS, RF;SISCOVICK, DS
背景医生面临着越来越大的压力，需要向高胆固醇血症患者提供饮食建议。为了设计有效的以医生为基础的治疗方案，需要更好地了解当前的饮食咨询实践及其决定因素。使用以前测试的可靠性和有效性的调查，我们研究了饮食知识，态度，信念，组织障碍，和胆固醇管理的治疗实践之间的关系，在60个居民和主治医生执业的普通医学诊所的大学医学中心，主要服务于农村和弱势群体的患者。调查于1988年10月在国家胆固醇教育计划指南发布之前进行。结果：应答率为100%。92%的受访医生认为饮食治疗可以有效降低胆固醇，68%的医生认为有责任提供这种治疗。然而，大多数人（72%）对饮食咨询准备不足，对自己帮助患者做出有意义的饮食改变的能力缺乏信心（95%），并引用组织障碍，如时间有限（72%）或教育材料不足（47%）。如果医生觉得自己准备好了进行咨询（r = 0.42，P < 0.001），对自己的咨询技能有信心（r = 0.39，P < 0.01），或者报告自己遵循谨慎饮食（r = 0.36，P <0.01），他们更有可能报告以行为为重点的饮食咨询实践。我们讨论了这些发现的意义，以及它们应该如何指导以医生为基础的饮食干预措施的设计，以降低胆固醇。
Background. Physicians face increasing pressure to counsel their hypercholesterolemic patients about diet. To design effective physician-based treatment programs, a better understanding of current dietary counseling practice and its determinants is needed.Methods. Using a survey previously tested for reliability and validity, we examined the relationship of dietary knowledge, attitudes, beliefs, organizational barriers, and treatment practices for cholesterol management among 60 resident and attending physicians practicing in the general medicine clinic of a university medical center that serves primarily rural and disadvantaged patients. The survey was administered in October of 1988 prior to the release of the National Cholesterol Education Program Guidelines.Results: The response rate was 100%. Ninety-two percent of physicians surveyed believe that dietary treatment effectively lowers cholesterol and 68% feel responsible for providing such therapy. However, most (72%) feel ill-prepared to give diet counseling, lack confidence in their ability to help patients make meaningful dietary changes (95%), and cite organizational barriers, such as limited time (72%) or inadequate educational materials (47%). Physicians were more likely to report behaviorally focused diet counseling practices if they felt prepared to counsel (r = 0.42,P< 0.001), were confident in their counseling skills (r = 0.39,P< 0.01), or reported personally following a prudent diet (r = 0.36,P< 0.01). We discuss the implications of these findings and how they should guide the design of physician-based dietary interventions for cholesterol reduction.