Physician Perceived Barriers and Solutions to DASH Diet Recommendations for Hypertension Prevention and Management

Background: The Dietary Approach to Stopping Hypertension (DASH) is considered first-line therapy for hypertension, yet clinical practice implementation remains suboptimal. Methods: We designed a survey to assess four domains: (1) Provider beliefs/knowledge of DASH benefits, (2) Patient characteristics influencing likelihood of recommendation, (3) Practice barriers to provision of DASH diet advice, and (4) Resources of perceived value. The survey was sent to University of Colorado School of medicine primary care providers practicing in the Denver metro area. Results: The survey was sent electronically to 149 providers, with 49 (33%) responders. Most (65%) believed DASH diet is as effective at lowering blood pressure as adding a medication. The most common patient and practice barriers influencing the decision to provide DASH dietary advice included perceived low patient motivation (90%) or ability (86%) to implement DASH diet, lack of provider time (71%), and lack of patient-directed educational resources (67%). Resources providers identified as useful included resources accessible through the electronic medical record, (88%), a dietician (83%), and printed patient-education materials (59%). Conclusion: Interventions to increase provision of DASH dietary advice should focus on identifying eligible patients, accessible and well-disseminated educational materials, and expanded access to evidence-based interventions involving dieticians.