'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service.
Hannah L Mayr, Holly Savill, Lynette Law, Katrina L Campbell, Jan Hill, Michelle Palmer, Ingrid J Hickman, Jaimon T Kelly
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引用次数: 0
Abstract
Aims: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service.
Methods: Semi-structured individual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post-acute community settings in a metropolitan health service in Australia. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.
Results: A total of 3 themes with 10 subthemes were identified. (a) 'Treatment prioritisation': important role of nutrition in risk factor management; competing priorities with complex patients; weight loss as a priority; and dietitians individualise. (b) 'Diverse roles in providing diet advice': a tension between nutrients, restrictions and diet quality; patients seek and trust advice from non-dietitians; and providing nutrition information materials crosses professions. (c) 'Dietitian access': variable integration and resourcing; access governed by clinician discretion and perceived patient interest; and bespoke application of referral pathways.
Conclusions: Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.
期刊介绍:
Nutrition & Dietetics is the official journal of the Dietitians Association of Australia. Covering all aspects of food, nutrition and dietetics, the Journal provides a forum for the reporting, discussion and development of scientifically credible knowledge related to human nutrition and dietetics. Widely respected in Australia and around the world, Nutrition & Dietetics publishes original research, methodology analyses, research reviews and much more. The Journal aims to keep health professionals abreast of current knowledge on human nutrition and diet, and accepts contributions from around the world.