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In need of some advice

Strategies need to be developed to improve the delivery of nutrition advice in general practices, according to a recent study. By Annie May.

Nutrition-related chronic disease and weight issues are on the rise in Australia but some at-risk patients aren’t getting the proper counselling and advice from practice nurses and GPs who are faced with growing time restraints, a lack of resources and not enough training.

In an Australian study that explored the role of GPs and practice nurses (PNs) in providing nutrition advice in a primary health setting, researchers found that while the majority of GPs and PNs believed dietary assessment and counselling is a role for both, neither group had faith in their knowledge and skills to do so.

Only 42 per cent of the participating PNs believe they have the knowledge to provide nutrition counselling and 50 per cent think they have the skills. Of the participating GPs, just 30 per cent reported a belief in having the knowledge and 20 per cent said they had the skills.

Both groups said they didn’t have adequate time to provide nutrition advice (GPs 60 per cent, PNs 50 per cent) but PNs reported spending more time discussing nutrition than GPs, with a majority of PNs spending five to ten minutes, compared with one to five minutes for GPs.

All participants said they required more nutrition information to be able to effectively provide nutrition advice and that having education material available was an important factor in their decision to provide advice.

Another barrier identified was the lack of reimbursement to provide counsel, with 50 per cent of GPs saying it influenced their decision. This was compared to 17 per cent of PNs with the researchers saying this was probably because they are paid a salary while GPs are paid per consultation.

However, the study said comments by many of the nurses suggested reimbursement was an issue in general practices. “Ultimately, activities that attract a rebate will be given a higher priority within the practice,” wrote the researchers Lana Mitchell and Lesley MacDonald-Wicks from the University of Newcastle’s faculty of health and Sandra Capra from the University of Queensland’s Centre for Clinical Research.

Patients and private practice dietitians were also questioned. The findings from the patients raised some concern that the public still didn’t understand the role and expertise of the practice nurse.

Two-thirds of GP patients and one-third of PN patients receiving nutrition or weight management said they would be more likely to change behaviour if it was recommended by their GP rather than the PN.

Reasons for this included the belief that GPs were more qualified and an existing good relationship with the GP. On the other side, reasons in favour of PNs were the perception that they were more approachable and understanding, making it more comfortable to discuss lifestyle factors.

The majority of dietitians believed that GPs have a role in providing nutrition advice, with half saying it should be initial basic advice. About one-quarter of these specified this should be followed by referral to dietitians. The main reason given for GPs having a role in providing nutrition advice was that they are the first point of contact. The main reasons why GPs were not perceived to have a role mirrored the reasons put forward by the GPs and PNS; their lack of nutrition knowledge, skills or training, their poor quality or inaccurate provision of nutrition advice and lack of time

The majority of dietitians did not think that PNs had adequate nutrition training and knowledge to provide brief advice but most agreed that with the training PNs had a role in providing initial brief advice before referring to dietitians.

Strategies suggested by dietitians for increasing the number of patients receiving nutrition advice in general practices include making available appropriate resources such as patient education materials, increasing nutrition education and training for GPs and PNs and developing concise and easily interpreted nutrition-related best practice guidelines.

“Additional nutrition training was believed to have changed nutrition counselling practices. The literature shows that training increased nurses’ perceived level of knowledge and confidence to discuss diet with patients,” said the study.

However, the researchers said that even with extra training, nurses and doctors needed to have access to scripted nutrition advice for specific conditions developed by dietitians.

“Scripted nutrition advice developed by dietitians for specific conditions allows GPs and PNs to confidently provide basic evidence-based messages to patients without extensive training. It is essential that if GPs and PNs provide basic nutrition advice to patients that the advice is accurate and evidence based,” the researchers wrote.

Findings from the study were published in the recent issue of the Australian Journal of Primary Health. For the full report go to http://www.publish.csiro.au/nid/261/paper/PY10101.htm

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