The relevance of the Heart Foundation of Australia\u27s dietary recommendations for adult Australians : a comparison of views of general practitioners, cardiologists and dietitians

PURPOSE: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia\u27s dietary recommendations for adult cardiac patients. BASIC PROCEDURES: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation. MAIN FINDINGS: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake. CONCLUSIONS: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education.<br /

From recruitment to consent : what makes doctors want to participate in the review of lifescripts

Aims &amp; rationale/Objectives : The Australian Government wants the Lifescripts resources to be utilised by general practices. Therefore a national review has been commissioned.The aim of this presentation is to identify characteristics, barriers and enablers associated with consenting and non-consenting general practices within two Victorian general practice networks.Methods : Recruitment of general practice staff consisted of three phases: promotion, communication and practice visits. Recruitment occurred from Sept to November 2007. Data was collected via face to face interviews.Principal findings : Prior to the consenting phase 17 practices expressed interest in participation. At the consent phase, 10 general practices (7% response), 17 GPs (3% response), and three practice nurses (2.5% response) agreed to participate.Consenting practices had more: principal GPs involved in the recruitment process; greater intention to implement Lifescripts around MBS numbers; more experience with change management strategies, consulting health professionals, and defined their practice population(s) as middle aged and older.Non-consenting practices identified the following barriers: lack of support from principal general practitioners or owners; lack of capacity to incorporate Lifescripts into existing computer software; lack of financial incentive; heavy work loads and poor patient response to 45 health check.estImplications : Inform general practices of a resource to assist them to detect and prevent chronic disease, and enable early intervention strategies. The benefit of this presentation is that it identifies the importance of determining barriers and enabling factors when implementing a lifestyle based service program at general practice level.Presentation type : Poster<br /

Is dietary management a responsibility of general practitioners? The views of Victorian general practitioners

Rationale : Australia is experiencing an evolving healthcare system, resulting in an aim of systematic managed care for patients with chronic disease. One outcome has been debate on doctors\u27 dietary management responsibilities.Aim : To identify general practitioners\u27 perceptions of their dietary management responsibilities for adult cardiac patients.Methods : A Two phase study was conducted. First, semi-structured interviews with 30 Melbourne general practitioners were conducted to gather preliminary information about dietary management. The results informed a questionnaire for the second phase. This was completed by 248 general practitioners (30%) in Victoria.Principal findings : Themes arising in interviews, and also supported by cross-sectional survey showed that doctors perceive themselves as filling one or more of three roles. The majority (87.4%) endorsed an \u27Influencing\u27 role, 27.4% endorsed \u27Dietary Educator\u27 and 44.0% a \u27Coordinator\u27 role. The Influencer role was characterised by encouragement of dietary behaviour change, such as discussing benefits and consequences of inaction to dietary change. The Educator role was characterised by the provision of a range of behaviour change strategies- \u27how to\u27 achieve change. \u27Coordinators\u27 reported the provision of dietary counselling belonged to dietitians alone.Implications : The results indicate doctors\u27 awareness of need for patients\u27 dietary education should be increased. This could be accomplished by one-on-one education. Patients\u27 access to dietary education should also be facilitated by doctors\u27 referring on. Embedding dietary management protocols in doctors\u27 managed care templates could improve patients\u27 access to dietary education and enhance doctor\u27s collaborative roles.Presentation type : PaperSession theme : Getting Evidence into Practice 2<br /

General practitioners\u27 nutrition promotion among cardiac patients

General practitioners fall into three categories in their pursuit of dietary counselling: little involvement, or provider of referrals, or they have strong involvement. The barriers to dietary counselling are inadequate partnerships with dietitians, patients suffering multiple medical conditions and the view that HMG-CoA-reductase-inhibitors (statins) reduce the need for dietary change

Facilitating patients' dietary change: a review of dietitians' correspondence practices with general practitioners

Aim: Dietitian and general practitioner collaboration in the nutrition care of a patient is important to assist patients to achieve their nutrition goals. This paper aims to review the published literature on dietitians' correspondence practices with recipient general practitioners regarding nutrition interventions recommended to patients. Methods: A literature search was conducted of publications from 1995 to December 2009. Key words were used to search the electronic databases Medline, CINAHL Plus, ProQuest, PsycINFO and Google Scholar. Twenty papers that addressed this topic were selected by two authors for inclusion in the review. Results: There is evidence that dietitians often fail to provide general practitioners with formalised correspondence that describes dietitians' nutrition interventions with patients. Doctors report they lack patient information via dietitians' correspondence. Information about nutrition care of hospital patients often remains within hospital records. Doctors prefer standardised letter formats with content presented succinctly. The letter should include a nutrition diagnosis, agreed goals, a plan for ongoing dietetic visits and instructions for a general practitioner's supportive actions. Conclusion: Dietitians need skill in drafting reports or letters useful for general practitioners by selecting content of value to doctors and using a suitable style. Implementation of shared electronic records in Australia will facilitate information transfer to help realise collaborative patient care. Further investigations of dietitian-general practitioner correspondence are warranted to determine best practice

Nutrition care for adult cardiac patients: Australian general practitioners\u27 perceptions of their roles

Background. Australia has implemented systematic managed care for patients with chronic disease. Little is known about how GPs perceive their nutrition care role in this system. Objective. To examine GPs perceptions of their roles in the nutrition care of cardiac patients and to identify factors that influence their role. Methods. Multi-methods research design. Semi-structured interviews were conducted with a sample (n = 30) GPs Victoria, Australia. The resulting narratives were used to develop a quantitative questionnaire to survey a random sample of GPs. Principal components analysis was conducted to reduce the role items to a small number of underlying dimensions. The association between roles and demographic variables were examined using stepwise multiple regressions. Results. In all, 248 GPs (30% response) participated. Three main roles were established: Influencing,Coordinating and Nutrition Educator role. Together, the roles explained 54% of the total variance. Demographic variables were not associated with these roles. The majority (mean = 88%) endorsed the items which loaded on to the Influencing and Coordinating (mean = 49%) roles. Short consultation time, use of prescribed medications and perception of patient attendance at cardiac rehabilitation reduced the priority for nutrition education. Conclusions. This study highlights the importance of developing more effective team care arrangements for patients with chronic disease and working with the medical education colleges to develop education resources for doctors that include an explanation of the non-pharmaceutical as well as the pharmaceutical treatment for each chronic disease condition

Enhancing the dietary management of general practice patients through collaborative care: perspectives of general practitioners and dietitians

Aim:&ensp; To describe how general practitioners and dietitians view their role in the dietary management of cardiac patients and to provide insights on how to facilitate collaborative care.Methods:&ensp; Two studies were conducted in Victoria (Australia) 2005&ndash;2006. Study One: semi-structured interviews with general practitioners. Study Two: cross-sectional quantitative surveys of general practitioners and dietitians. Study One: texts were analysed using the grounded theory approach. Study Two: frequency analysis was conducted and chi-squared test for independence was used to explore the impact of age, sex and consultation time on the role and reporting scales.Results:&ensp; Study One: Themes arising from the interviews with 30 general practitioners showed their involvement in dietary management fell into three broad roles: &lsquo;Influencing&rsquo;, &lsquo;Coordinator&rsquo; of referrals and dietary &lsquo;Educator&rsquo;. They described dietetic education as a process that included dietary assessment, education, application of behavioural change techniques and reporting back to general practitioners. Study Two: Respondents were 248 general practitioners (30% response) and 180 dietitians (60% response). General practitioners\u27 counselling consisted mostly of advocating for dietary change, coordinating dietetic referrals and reinforcing dietitians\u27 recommendations. General practitioners considered dietary education as the role of dietitians. Dietitians reported a much broader role in the management of patients with some overlap with general practitioners\u27 roles.Conclusions: &ensp; The findings indicate the need: (i) for more structured reporting to ensure general practitioners receive appropriate information to enable them to reinforce dietetic counselling and recommendations; and (ii) to streamline the communication process in order to expedite dietitians\u27 reports to general practitioners.<br /

The relevance of the Heart Foundation of Australia&apos;s dietary recommendations for adult Australians: a comparison of views of general practitioners, cardiologists and dietitians

Purpose: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia&apos;s dietary recommendations for adult cardiac patients. Basic procedures: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation. Main findings: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake. Conclusions: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education