PHYSICIAN TRAINING FOR PATIENT-CENTERED NUTRITION COUNSELING IN A LIPID INTERVENTION TRIAL

Bockground. We examined the effect of a 3-hr training program on physicians' lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported nutrition intervention practices, and counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians' use of dietary counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased (x) over bar(pre) = 5.4, (x) over bar(post) = 9.2; t = 9.9; P less than or equal to 0.001). In this regard, there were increases in the use of 7 of the 14 specific counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ((x) over bar(pre) = 3.2, (x) over bar post = 4.0; t = 4.25; P < 0.001), confidence in having an effect ((x) over bar(pre) = 3.3, (x) over bar(post) = 3.9; t = 3.16; P < 0.01), perception that materials were available to aid intervention (x) over bar pre = 2.7, (x) over bar post = 4.0; t = 5.29; P < 0.001), and perception that they have access to a nutritionist ((x) over bar(pre) = 3.5, (x) over bar = 4.0; t = 2.63; P < 0.01). They rated the value of the program between very good and excellent. Conclusion. Results of this 3-hr educational program indicate that physicians in an HMO are responsive to the teaching of specialized skills deemed important for promoting health behavior change in their patients. (C) 1995 Academic Press, Inc.