Point-of-Care Technology Supports Implementation of 5As Framework for Dietary Behavior Change

Abstract

Background

Practice guidelines recommend physicians discuss diet with patients using the 5As framework: Assess behavior, Advise personalized behavior change recommendations, Agree on goals, Assist by addressing barriers/securing support, and Arrange follow-up. We developed Nutri, a point-of-care software that synthesizes diet data collected before the appointment (Assess), provides evidence-based recommendations (Advise), guides patients and providers to select one diet goal (Agree), tailors take-home materials to support goal attainment (Assist), and facilitates follow-up via automated clinical note (Arrange).

Objective

Evaluate differences in diet counseling among physicians with and without access to Nutri during a simulated appointment.

Study Design, Settings, Participants

We randomized primary care resident physicians to discuss nutrition during a simulated diabetes appointment with a patient actor. Control physicians (n=13) were prompted to discuss diet with the patient. Nutri physicians (n=11) were oriented to Nutri and prompted to use it in the simulation. Simulations were videorecorded.

Measurable Outcome/Analysis

Time in simulation. Deductive coding of recordings using U.S. Preventive Services Task Force 5As definitions.

Results

Control simulations were ∼3 minutes longer than Nutri (Mean±SD = 9.23±3.87 vs. 6.01±1.35). Control physicians assessed by asking patients to recall a typical eating day; Nutri physicians highlighted successes and potential areas for improvement, referring to Nutri's automated assessment. Control physicians advised on many topics, differing from Nutri physicians who advised on 1-2 high-impact areas. Nutri physicians and patients agreed on one goal after considering patient self-efficacy, whereas Control physicians gave physician-led recommendations. Both groups assisted by giving food examples to address the patient’s knowledge barrier. Nutri physicians asked how these foods could be incorporated into the patient’s diet and provided goal-focused take-home materials. Alternatively, Control physicians offered various ideas, but no post-appointment support. Control physicians arranged by mentioning they would discuss diet at the next visit, whereas Nutri physicians planned to discuss goal progress.

Conclusions

While Control aligned with the 5As framework, Nutri sessions were less variable, more goal-focused, and patient-led. Nutri enables feasible 5As implementation that aligns with behavior change theory, which is likely to increase successful patient dietary management.

Funding

None