Lana J. Mitchell

Nutrition advice in general practice: the role of general practitioners and practice nurses

General practice is an ideal setting to be providing nutrition advice; however, it is important that the role of general practitioners (GPs) and practice nurses in providing nutrition advice is acknowledged and defined. This article aims to discuss the role of GPs and practice nurses in the delivery of nutrition advice. Ten general practitioners and 12 practice nurses from a NSW urban Division of General Practice participated in questionnaires and a Lifescripts implementation study, as well as their consenting patients receiving Lifescripts (n=13). An online survey was conducted with 90 Australian private practice dietitians. Semi-structured telephone interviews were conducted with 52 Australian private practice dietitians. The provision of basic nutrition advice is acknowledged to be part of the role of GPs and practice nurses, as they are the first point of contact for patients, allowing them to raise nutrition awareness. However, it is important that this advice is evidence based and able to be delivered in a time-efficient manner. Increased nutrition education and the availability of appropriate resources and nutrition-related best practice guidelines will assist in this process.

Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials

BACKGROUND A dietetic consultation is a structured process aimed at supporting individual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery. OBJECTIVE The aim of this systematic review was to evaluate the evidence of the effectiveness of individual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes. STUDY DESIGN ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual. MAIN OUTCOME MEASURES Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05). RESULTS Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary, anthropometric, or clinical indicators between intervention and comparator groups. When focusing specifically on each studys stated aim, significant improvements favoring the intervention compared with control were found for the following management areas: glycemic control (four out of four studies), dietary change (four out of four studies), anthropometry (four out of seven studies), cholesterol (two out of eight studies), triglycerides (one out of five), and blood pressure (zero out of three) studies. CONCLUSIONS Dietetic consultations for adults in primary care settings appear to be effective for improvement in diet quality, diabetes outcomes (including blood glucose and glycated haemoglobin values), and weight loss outcomes (eg, changes in weight and waist circumference) and to limit gestational weight gain (Grade II: Fair evidence). Research evaluated in this review does not provide consistent support for the effectiveness of direct dietetic counseling alone in achieving outcomes relating to plasma lipid levels and blood pressure (Grade III: Limited evidence). Therefore, to more effectively control these cardiovascular disease risk factors, future research might explore novel nutrition counseling approaches as well as dietitians functioning as part of multidisciplinary teams.

Private practice in rural areas: an untapped opportunity for dietitians.

OBJECTIVE The purpose of this study was to describe the current demography of rural dietetic private practice and to determine the drivers and barriers for further development. DESIGN A sequential explanatory mixed methods approach was used. Document searches and semistructured in-depth individual interviews were used to collect quantitative and qualitative data. SETTING Six rural case study sites of dietetic service delivery in rural northern New South Wales. PARTICIPANTS Forty key informants including past and present dietitians, dietetic managers and health service managers were recruited, of these a subset of 15 interviews included discussion or comments about private practice in rural areas. MAIN OUTCOMES MEASURES Themes identified from the interview transcripts, Medicare enhanced primary care consultation data and public/private dietetic staffing levels from document searches. RESULTS Private practice staffing ranged between 0% and 26% of the dietetic workforce across the six sites in 2006. Themes relating to the drivers and barriers for private practice were identified: financial factors, job satisfaction, opportunities for private practice and establishing private practice. CONCLUSIONS There is an opportunity for growth of private practice to meet the gap in public dietetic services in rural areas.

Investigating the Perceptions of Primary Care Dietitians on the Potential for Information Technology in the Workplace: Qualitative Study

Background Chronic diseases are the leading cause of morbidity and mortality worldwide. The primary health care setting is an effective avenue for the management and prevention of chronic diseases. Dietitians working in this setting assist with the management of modifiable risk factors of chronic diseases. However, health care professionals report challenges in providing care in this setting because of time and financial constraints. Information technology offers the potential to improve health care quality, safety, efficiency, and cost-efficiency, but there exists limited understanding of dietitians’ application of technology in this setting. Objective The objective of this study was to explore the perceptions of primary care dietitians about using information technology in their workplace. Methods We recruited 20 Australian primary care dietitians using purposive and snowball sampling for semistructured telephonic interviews. Interview questions aimed to gain an understanding of dietitians’ perceptions about sharing patient outcomes through a national database and the benefits, disadvantages, feasibility, and barriers of using information technology. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed for emerging themes and subthemes. Finally, the technologies used by participants were collated by name and researched for their key attributes. Results The following 4 distinct themes emerged from the data: information technology improving the efficiency of practice tasks, experiencing barriers to using information technology in practice, information technology enhancing outcomes through education and monitoring, and information technology for sharing information with others. Participants identified several advantages and disadvantages of using technology and expressed willingness to share patient outcomes using a Web-based database. Conclusions This study suggests that information technology is perceived to have benefits to dietitians and patients in primary health care. However, to achieve the optimal benefit, support is required to overcome barriers to integrate information technology into practice better. Further development of patient management systems and standardized Web-based data collection systems are needed to support better usage by dietitians.

Structural change through Medicare funding - What does it mean for dietetics?

Best practice guidelines for weight management often fail to identify the depth and frequency of follow up and reinforcement of behaviour change. 152 obese adults were randomised to one of three iso-energetic diets. Participants were followed up monthly in person for 6 months and at 9 and 12 months, with twice-monthly telephone support during the 6 month intervention period. Dietary compliance was assessed at each phone call. Overall dietary compliance was defined as compliant on >6 phone calls. Participants were considered successful if they maintained >5% weight loss from baseline at 3, 6 and 12 months inclusive. Intention to treat repeated measures General Linear Model analysis showed successful participants accessed more phone calls than those who lost 50% phone calls (overall compliant 98% vs. not compliant 55%; overall compliant 100% vs. not compliant 43%, respectively) (χ2 = 45.5, p < 0.001; χ2 = 50.7, p < 0.001). Results suggest that professional support may not directly produce weight loss success but is associated with better outcomes. More research is required to further inform best practice guidelines.We investigated the interaction between dietary quality and television viewing time with abnormal glucose metabolism (AGM; impaired fasting glucose, impaired glucose tolerance or newly diagnosed diabetes). Data were from a population-based cross-sectional study (AusDiab) including 4,754 men and 5,849 women ≥25 years without diagnosed diabetes. Diet was measured by food frequency questionnaire, scored using the Diet Quality Index-Revised, and categorised as high, medium or low. Television time was categorised as low (≤14 hours/week) or high (>14 hours/week). Logistic regression models adjusting for known confounding variables, including physical activity and waist circumference, were constructed separately for men and women. For men and women, the odds of having AGM was 1.32 (95% CI 1.03–1.64, p = 0.030) in those with low diet quality compared to those with high diet quality. The interaction between television viewing time and diet quality was significant only for women. In women, relative to those with low television time and high diet quality, the odds ratio of having AGM was 1.74 (95% CI 1.20–2.51, p = 0.004) in those with low television time and low diet quality, 1.40 (95% CI 1.07–1.84, p = 0.015) in those with high television time and moderate diet quality and 2.52 (95% CI 1.62–3.92, p < 0.001) in those with high television time and low diet quality. The odds ratios for low television time and moderate diet quality (1.11, 95% CI 0.79–1.54) and high television time and high diet quality (1.07, 95% CI 0.77–1.48) were not significant. High diet quality, together with reduced sedentary time, is important for reducing the risk of AGM.