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The effectiveness of nutrition counselling by Australian General Practitioners

European Journal of Clinical Nutrition volume 59, pages S140–S146 (2005)Cite this article

Abstract

Objective:

To determine whether General Practitioners (GPs) consider or provide nutrition counselling for hypertension, diabetes, lipid disorders, ischaemic heart disease (IHD), overweight or obesity, and whether GPs include assessment of the patient's usual diet, assessment of the patient's readiness to change their diet, provision and discussion of nutrition leaflets when counselling.

Design:

A self-completed questionnaire.

Setting:

New South Wales, Australia.

Subjects:

A total of 399 GPs were surveyed using a division mailing list.

Methods:

Questionnaires were distributed in May 2004 with two reminders provided at four-weekly intervals.

Results:

Of the 399 GPs, 28 no longer practiced at the address while nine were on extended leave. Of the remaining 362, 50% responded, 5% declining to participate, while 163 (45%) completed the questionnaire. GPs were less likely to strongly agree to consider nutrition for hypertension (37%), IHD (61%) and overweight (68%), than diabetes (86%), lipid disorders (82%) and obesity (83%). They were also less likely to strongly agree to provide nutrition for hypertension (22%), IHD (46%) and overweight (45%), than diabetes (79%), lipid disorders (71%) and obesity (68%). In total, 97% of GPs provided some nutrition counselling, with 66% ‘often’ assessing the patients diet and 59% ‘often’ assessing the patient's readiness to change their diet. In total, 45% were unaware of stage of change behaviour theory. A total of 85% used nutrition leaflets and 59% ‘often’ discussed these with their patients.

Conclusions:

Determining what are the barriers to nutrition counselling for hypertension, IHD and overweight is urgently needed. Educating GPs on stage of change behaviour theory could increase the efficacy of the counselling provided.

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Author information

Authors and Affiliations

  1. Discipline of General Practice, The University of Newcastle, Callaghan, 2308, NSW, Australia

    L Nicholas & D Pond

  2. Australian Food and Grocery Council, Canberra, 2604, ACT, Australia

    D C K Roberts

Authors
  1. L Nicholas
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  2. D Pond
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  3. D C K Roberts
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Corresponding author

Correspondence to L Nicholas.

Additional information

Guarantor: Lisa Nicholas.

Contributors: LN was responsible for the research design, data collection, data analyses and writing of the manuscript. DP and DCKR provided advice and consultation on all aspects of the research and writing of the manuscript.

Discussion after Pond

Van Woerkum: I saw from your data that there was especially around overweight and obesity a big gap between considering information and giving information in reality. Perhaps GPs are afraid to talk about obesity as it is a very difficult subject compared with other subjects.

Pond: I guess there are limitations to the questionnaire data, we do not know. We do need to do some in-depth interviews to find out. But I certainly think that GPs get quite worried if they have to talk about obesity. This probably blocks them.

Summerbell: In terms of obesity, yes it is a very difficult topic, and because of that it is a very interesting topic. But I would not at all know whether or not it is more difficult to talk about obesity or decreasing fat intake, if the persons giving that advice are also overweight themselves. It would be interesting to see if it was given more by GPs who were not overweight or obese. And I think it is very difficult if you are smoking to say to the person in front of you to stop smoking. However, you can hide your smoking habits, but you cannot hide how thin or fat you are.

Helman: What GPs say they do and what they really do when you videotape them are different things. I would like to know what you think about what we can win by getting more details about what they are actually doing. Because if a GP says: ‘I advise my patients to reduce fat’, what does that mean? Some of the advice they claim to be giving might be completely misleading.

Pond: It is a worry. We asked the GPs to fill in a one page questionnaire on what they had done, concerning 20 consecutive patients with one of these chronic diseases. So it would be interesting to see what the results of that are. One page is about the limit of what you can ask GPs.

Laws: Just a comment about actual vs self-reported clinical practice research, we found a very big difference in our audit in the UK. Where about 60% of GPs said that they would regularly refer a patient to a dietician, our actual clinical audit showed that only 4% of the patients had been referred to a dietician. Also about perceived knowledge and confidence. We found that confidence was relatively high regarding obesity, but the actual knowledge was low. So that is a bit of a concerning situation.

Pond: If anything, these data show that these fairly low levels of advice giving are likely to be an overestimate. So that is a worry.

Brotons: Your data correspond very well with what we found in the Europrev survey. We also found a discrepancy between what they consider and what they provide. We did not find differences between obese GPs and nonobese GPs in advising obese patients to reduce weight, and in their perceived effectiveness. Of course we do not know what the outcome is in real practice, but at least we found this in terms of perception. And I also would like to ask: what is the role of practice nurses in Australia? When we asked them, in Europe both GPs and nurses said that they would give dietary advice.

Pond: About the overweight GPs, it would be interesting to see if they are as effective as normal-weight GPs. Maybe they do provide the advice just as often, but are not as effective. And about the nurses, Australian GPs have discovered practice nurses in the last 5 years. In our area, there were 55 nurses across the 399 GPs in 2000; now it is nearly 200. So in these 4 years, the number of practice nurses quadrupled. It is driven by an increased demand, and also by a fallen number of GPs and a rising patient population per GP although this is not the same in every area. It is a very interesting development. We think that practice nurses have a role in chronic diseases management and nutrition counselling.

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Nicholas, L., Pond, D. & Roberts, D. The effectiveness of nutrition counselling by Australian General Practitioners. Eur J Clin Nutr 59 (Suppl 1), S140–S146 (2005). https://doi.org/10.1038/sj.ejcn.1602187

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