Exploring Strategies to Better Equip Primary Care Physicians to Address Diet With Patients

Evidence supports a longstanding gap in physicians’ capacity to counsel about diet. Momentum to address training needs is growing; however, primary care physicians (PCPs) also report practice barriers. This study seeks to better understand the complex problem PCPs face to inform solutions and explores in greater depth foundational nutrition training needs.Incorporating human-centered design, this study encompasses semi-structured interviews and a survey with PCPs. Interviews explored PCPs’ current experience addressing nutrition. Findings informed a nutrition in primary care survey that included items regarding nutrition training experience and priorities. Survey and interview data were triangulated to corroborate and expand on findings relevant to nutrition training. Findings from interviews (n=32) revealed that while PCPs value nutrition and believe they have an important role in addressing diet, their role lacks clarity. PCPs describe learning their approach to nutrition primarily outside of formal training, resulting in variability and inconsistency in approaches and recommendations and general frustrations about their ability to give actionable guidance. While registered dietitians (RDs) are often viewed as valuable support, PCPs describe multiple challenges to RD utilization and subsequently at times may be the only ones with the opportunity to address diet. Additional system- and societal-level barriers further complicate their experience. Survey participants included 144 PCPs, of whom 115 completed the Nutrition Training section. Average perceived adequacy of nutrition training was 1.51/3.00 (0.67). The majority (n=88, 76.5%) reported primarily learning their approach to nutrition outside of medical school and residency, corroborating interview findings. The highest training priorities were discussing weight in a non-stigmatizing manner 3.83/4.00 (0.40) and brief dietary counseling for overall wellness/disease prevention 3.77/4.00 (0.44). Highest priority conditions for dietary counseling were obesity 3.89/4.00 (0.34) and prediabetes/diabetes 3.81/4.00 (0.49). Results support the need to clearly define a realistic role for PCPs as generalists addressing nutrition. Clarified expectations can inform training and guiding frameworks and strategies for giving practical, evidence-based guidance. Findings identify nutrition competencies meaningful to real-world practice for prioritizing in training programs. PCPs also need increased support through access to resources, strategies to improve RD collaboration, and attention to system- and societal-level challenges influencing dietary interventions in primary care.