The tension between efficiency and effectiveness: a study of dietetic practice in primary care

Abstract

Background: Primary healthcare dietitians have a vital role to play in the prevention and management of chronic disease. Working in primary care requires efficient and effective management of practice to ensure client and practitioner needs are met. The present study aimed to explore the way in which primary care dietitians in Australia view the constructs of efficiency and effectiveness within the context of their practice. Methods: The study used an exploratory qualitative design within a pragmatist framework. Individual semi-structured telephone interviews were conducted with Australian primary care dietitians. All interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Results: Twenty dietitians (17 females) working as private practitioners in primary care from three Australian states participated in the present study. Three themes emerged from the data. The first theme revealed that seeking efficiency and especially effectiveness were important to primary care dietitians and that there was a tension between the two. The second theme identified that efficiency and effectiveness are influenced by personal and structural factors. The final theme explored how dietitians are actively seeking ways to be more efficient and effective, including supportive networks, as well as the utilisation of technology. Conclusions: Achieving a balance between efficiency and effectiveness in primary care dietetics is challenging to practitioners, who may require further training and support to enhance productivity, time management and resource utilisation. Structured issues exist for the workface. Further studies are required to quantify these findings and to explore whether it is possible to optimise efficiency and effectiveness and achieve sustainability of the dietetic workforce in primary care. 259

Quality improvement strategies enhance primary care dietetics: A systematic review and meta‐analysis

“…Effectiveness, efficiency and person-centredness were the WHO quality elements most frequently addressed in this review. Effectiveness and efficiency were commonly addressed together, which complements the findings in a qualitative study by O'Connor et al 38 in which primary care dietitians perceived the two elements as being intertwined. Only two RCTs in the current review employed at least one form of technology, which is surprising given that previous research has identified that dietitians perceive technology as improving both efficiency and effectiveness.…”

“…Only two RCTs in the current review employed at least one form of technology, which is surprising given that previous research has identified that dietitians perceive technology as improving both efficiency and effectiveness. [38][39][40] This may be a result of barriers to technology use, which include not being familiar with available technology or how to use it, and appropriateness for the patient population. 40 Studies that addressed person-centredness focused on developing the patient's self-management skills rather than the dietitian's counselling skills.…”

“Dietitians May Only Have One Chance”—The Realities of Treating Obesity in Private Practice in Australia

“…This tension has been identified by Allied Health Professionals Australia who contend that the “current fees [for the Medicare rebate] remain well below the true cost of providing adequate patient care and are limiting access for many of those with the greatest need.” [ 41 ]. In addition, a qualitative study exploring Australian private practicing dietitians understanding of efficiency and effectiveness reported that finding a balance between efficiency and effectiveness was difficult when working in small business or as a contractor [ 44 ]. This paper posited that increased use of health technology may help streamline administration duties that curtailed private practitioners’ billable hours [ 44 ].…”

“…In addition, a qualitative study exploring Australian private practicing dietitians understanding of efficiency and effectiveness reported that finding a balance between efficiency and effectiveness was difficult when working in small business or as a contractor [ 44 ]. This paper posited that increased use of health technology may help streamline administration duties that curtailed private practitioners’ billable hours [ 44 ]. Lack of time, secondary to inadequate remuneration for time in dietetic practice, has previously been shown to hinder patient-centred care [ 42 ], the use of VLEDs [ 27 ], dietary assessment [ 45 ], and best practice in obesity management [ 25 ].…”

Percepção dos Usuários do Sistema Único de Saúde frente a atuação do nutricionista

“…O nutricionista da atenção primária possui um papel vital à promoção e proteção da saúde 25 . Uma das ações dentro das unidades de saúde são os atendimentos a pessoas com doenças crônicas não transmissíveis e, neste estudo, foi considerada uma atividade relevante para os usuários.…”