Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study

Abstract

BackgroundDespite the recommended guidelines on addressing diet for the management and prevention of obesity in primary care, the literature highlights that their implementation has been suboptimal. In this paper, we provide an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario.MethodsThree types of multidisciplinary primary care settings were included (2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic). Participants (n = 20) included in this study were nurse practitioners (n = 13) and family physicians (n = 7) supporting care for adult patients (18 years or older). In-depth interviews were transcribed, coded and the content was analyzed using an integrated approach.ResultsOur analysis showed that most PCPs used anthropometric measures such as weight for screening patients who would benefit from nutrition counselling with a dietitian. The topic of nutrition was generally brought up either during physical examinations, when patients were diagnosed with a chronic disease, or when blood markers were out of normal range. Participants also mentioned that physical examinations are no longer occurring annually, with most PCPs offering episodic care. All participants reported utilizing dietetic referrals, noting the enablers for providing the referral, which included access to an on-site dietitian. Nonetheless, dietetic referrals were mostly used when patients had an obesity-related co-morbidity. Participants mentioned that healthy eating advice was reinforced during follow-up visits with patients only when there was enough time to do so. Electronic Health Records (EHRs) were utilized to facilitate message reinforcement by PCPs, who perceived EHRs to be helpful for viewing what was discussed in the session with the dietitian.ConclusionsPCPs mostly used objective measures to screen for patients who would benefit from nutrition counselling rather than diet assessment, which undermines the importance of dietary intake and overemphasizes weight. With physical examinations occurring less frequently, there will be additional missed opportunities for addressing nutrition-related concerns. The presence of a dietitian on site allowed for PCPs to refer patients to nutrition counselling. Having sufficient time during medical visits and EHRs seemed to facilitate message reinforcement by PCPs in follow-up visits with patients.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0760-3) contains supplementary material, which is available to authorized users.

Dietitians' perspectives on patient barriers and enablers to weight management: An application of the social‐ecological model

“…54 Specifically, PCPs believed that electronic medical records that are used in these various healthcare settings allow for PCPs to reinforce the dietitian's message during follow-up visits with patients. 10 Nonetheless, participating RDs emphasised the importance for inter-professional collaboration and consistent message reinforcement as it was perceived to be effective in maintaining patient motivation over time.…”

“…Multidisciplinary clinics are comprised of various health professionals (e.g. family physicians, nurses, social workers, dietitians, pharmacists) who work in the same location and are beneficial because primary care providers (PCPs) may be more likely to bring up the topic of nutrition if they have an on‐site dietetic referral option …”

“…family physicians, nurses, social workers, dietitians, pharmacists) who work in the same location 8 and are beneficial because primary care providers (PCPs) may be more likely to bring up the topic of nutrition if they have an on-site dietetic referral option. 10 In Canada, Registered Dietitians (RDs) are regulated health professionals who specialise in conducting nutrition assessments, identifying nutrition problems as well as performing nutrition counselling and monitoring, based on clients' unique needs. 11,12 Their interventions have been shown to have significant benefits compared to standard care from a primary care provider [13][14][15][16] and their involvement in healthcare teams was found to lead to more sustainable behavioural changes.…”

Factors affecting access and use of preventive and weight management care: A public health lens

“…There should be, however, a sufficient number of health professionals on the team so that all patients who require allied health services have accessnot just those with more serious health conditions. 61 As for patients waiting for bariatric surgery, there is a perceived inequity for seeking this treatment which has a negative psychosocial impact. 62 In fact, it is estimated that 0.1% of the 1.5 million Canadians who would benefit from bariatric surgery receive publicly funded bariatric surgery each year with those receiving the surgery being disproportionately wealthier and more highly educated.…”

“…37,47,59,60 Conversely, PCPs may be more likely to refer patients to a dietitian if they have a cost-free referral option. 61 As a nurse practitioner noted in a study: “I think 90% of my patients wouldn’t go if they had to pay for it (session with a dietitian, p. 244).” 50…”