Barriers associated with doctors' referral to dietitians in Gauteng, South Africa

[摘要] INTRODUCTION: The objective of this study was to explore the barriers thatdoctors experience to referring patients to dietitians. The study sample (n = 700)included a selection of all practicing medical doctors and specialists in theGauteng province of South Africa. Registration with the Health ProfessionsCouncil of South Africa (HPCSA) was a prerequisite.METHOD: This was a quantitative study using a validated questionnaire e-mailedto participating doctors in order to determine factors affecting their referralpractices. The first part of the questionnaire consisted of demographic andgeneral information about the respondent and the second and third partsconsisted of a series of closed-ended questions that related to specific issues ofnutrition information and dietitian referral practices respectively. Thequestionnaire comprised a total of 21 questions. Subjects were sent thequestionnaire by e-mail and given four weeks to respond. Three reminder e-mailswere sent to encourage participation. Statistical analysis methods included:Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linearassociations, as well as Goodman and Kruskal tau tests.RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finallyuseable. Doctors who had a nutrition component in their training referred patientsto dietitians more often than those who did not and older doctors referred to adietitian less often (Chi-square tests, p < 0.05). A correlation was observedbetween the duration of medical practice and frequency of referral (p = 0.03)while gender had no influence on referral practice. A correlation (p < 0.001) wasalso found between frequency of referral and university of study with symmetricmeasures. Hyperlipidaemia, diabetes mellitus and obesity were identified as theconditions doctors would most likely refer to a dietitian. For 45% of the doctorsinsufficient time during consultation was the strongest barrier to providingnutrition councelling to their patients. The barrier identified most commonly wasthat doctors were unaware of dietitians in the vicinity of their practices (49%).Sixty four percent of doctors believed that better marketing by dietitians would increase their referrals, and 21.4% believed that the title 'nutritionist' or 'nutritionspecialist' would be more suitable for the profession of dietetics.CONCLUSION: The findings of the study indicate that a number of factorscontribute to the barriers that doctors experience to referring patients todietitians. Although the study was limited by a small sample, it neverthelessdraws attention to the responsibility of both dietitians and doctors to worktogether toward providing patients with a more efficient team approach treatmentand care system. More qualitative studies are needed to explore the identifiedbarriers further, especially within the South African context, as well as toestablish appropriate recommendations to overcome the barriers to referral.

[发布机构] Stellenbosch University