Family medicine residents' knowledge and attitudes about drug-nutrient interactions.

OBJECTIVE: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that health professionals recognize the importance of drug-nutrient interactions and educate patients to prevent adverse effects. Drug-nutrient interactions are an important issue in medical practice, but it is not clear how or if physicians are trained in this issue. METHODS: This investigation was a needs assessment that examined attitudes and knowledge about drug-nutrient interactions that was examined in a national sample of 834 family medicine residents in 56 residency programs. RESULTS: Most reported they had little or no formal training in drug-nutrient interactions in medical school (83%) or residency (80%). However, 79% believed it was the physician's responsibility to inform patients about drug-nutrient interactions, although many thought pharmacists (75%) and dietitians (66%) share this responsibility. Overall, residents correctly answered 61% +/- 19 of fourteen drug-nutrient interaction knowledge items. There was a slight increase in drug-nutrient knowledge as year of residency increased. CONCLUSIONS: Physicians' knowledge of drug-nutrient interactions may be improved by including nutrition education in the topics taught by physicians, nutritionists, and pharmacists using several educational strategies. Nutrition educators in particular can play a role in curriculum development about drug-nutrient interactions by developing, refining, and evaluating materials and educational tools. Nutrition educators need to provide this information in academic settings for the training of all health professionals as well as in patient education settings such as hospitals and public health clinics.

Comparison of primary care residents' confidence and clinical behavior in treating hypertension versus treating alcoholism.

PURPOSE: To compare the self-reported confidence and clinical behaviors of primary care residents in treating alcoholism versus hypertension. METHOD: Eighty-five residents, 36 in family medicine and 49 in primary care internal medicine, representing all years of the three-year training programs at two hospitals affiliated with the Brown University School of Medicine, were surveyed in 1988. Self-report questionnaires elicited demographic data and several responses (ranged on scales of 1, not confident or frequent, to 10, very confident or frequent) about the residents' confidence and frequency of use of clinical behaviors with both alcoholic and hypertensive patients. Paired t-tests were used to compare the responses about hypertension with those about alcoholism. RESULTS: Questionnaires were completed by 54 (63.5%) of the residents. No significant difference was found between the residents' responses by sex or program, but there was a significant difference (p < .0001) between the responses with regard to the two disorders. The residents had more confidence about their management of hypertension (a mean score of 8.81 versus 7.95 for alcoholism). They also reported greater use of appropriate clinical behaviors with hypertensive patients (mean scores in the very confident range of 7.5 to 8.2 compared with means in the moderate range of 4.9 to 7.1 for alcoholism). CONCLUSION: Both the family medicine and the internal medicine residents were significantly more confident in managing all aspects of hypertension than in managing alcoholism, and they reported significantly greater frequency in utilizing appropriate clinical behaviors for hypertension than for alcoholism.

Incorporating nutrition into pediatric practice: physicians and dietitians working together to improve children's health.

Clinicians are needed to include nutrition in the routine care of infants and children in office practice. Physicians play an important role in assessing nutritional status, diagnosing nutritional problems, providing a rationale for treatment, prescribing, performing brief counseling, referring to other resources if needed, and following up on the progress of their patients. Registered dietitians are the consultants of choice to assist pediatricians in the care of patients with nutrition-related disorders and are skilled in providing pediatric health promotion and disease prevention information. Consultant dietitians in the community can be found through contacting the local department of health or local hospital outpatient department. The American Dietetic Association also maintains a list of consulting dietitians throughout the United States. Funding mechanisms for engaging dietetic services vary from contracting with dietitians in private practice, local health departments, or hospital outpatient clinics, to employing dietitians on-site to provide counseling services in the office. Availability for third party payment for nutrition services varies with insurance carriers, individual policies, and region of the country. Incorporating nutrition into pediatric practice is important. Together, physicians and dietitians can work together to improve children's health.

A successful physician training program in cholesterol screening and management.

METHOD: Thirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter. RESULTS: Between 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.

A follow-up survey of family physicians' interest in and knowledge of nutrition.

Forty-two practicing family physicians completed a questionnaire about 33 nutrition topic areas. They were among 71 physicians who, over an eight-year period (1980-1988), completed an identical questionnaire upon entry to their first postgraduate year in the family practice residency program at Brown University/Memorial Hospital of Rhode Island. Specific topic areas were grouped into five scales. Perceived knowledge of these topics significantly increased (p less than .0001) in all areas except nutritional biochemistry. There was significantly less (p less than .0001) interest in learning more about nutrition. One major exception was that the physicians wanted to learn more about nutrition counseling. Another exception was that nutrition in the life cycle remained an area about which they wanted to learn more. The physicians rated nutritional skills as less relevant on the second questionnaire than on the first. The authors conclude that more emphasis on nutrition counseling skills and nutrition in the life cycle may be appropriate in medical education.