Barriers associated with doctors' referral to dietitians in Gauteng, South Africa
INTRODUCTION: The objective of this study was to explore the barriers that doctors experience to referring patients to dietitians. The study sample (n = 700) included a selection of all practicing medical doctors and specialists in the Gauteng province of South Africa. Registration with the Health Professions Council of South Africa (HPCSA) was a prerequisite. METHOD: This was a quantitative study using a validated questionnaire e-mailed to participating doctors in order to determine factors affecting their referral practices. The first part of the questionnaire consisted of demographic and general information about the respondent and the second and third parts consisted of a series of closed-ended questions that related to specific issues of nutrition information and dietitian referral practices respectively. The questionnaire comprised a total of 21 questions. Subjects were sent the questionnaire by e-mail and given four weeks to respond. Three reminder e-mails were sent to encourage participation. Statistical analysis methods included: Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linear associations, as well as Goodman and Kruskal tau tests. RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finally useable. Doctors who had a nutrition component in their training referred patients to dietitians more often than those who did not and older doctors referred to a dietitian less often (Chi-square tests, p < 0.05). A correlation was observed between 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) was also found between frequency of referral and university of study with symmetric measures. Hyperlipidaemia, diabetes mellitus and obesity were identified as the conditions doctors would most likely refer to a dietitian. For 45% of the doctors insufficient time during consultation was the strongest barrier to providing nutrition councelling to their patients. The barrier identified most commonly was that 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 ‘nutrition specialist’ would be more suitable for the profession of dietetics. CONCLUSION: The findings of the study indicate that a number of factors contribute to the barriers that doctors experience to referring patients to dietitians. Although the study was limited by a small sample, it nevertheless draws attention to the responsibility of both dietitians and doctors to work together toward providing patients with a more efficient team approach treatment and care system. More qualitative studies are needed to explore the identified barriers further, especially within the South African context, as well as to establish appropriate recommendations to overcome the barriers to referral.