- Title
- Improving the provision of nutrition advice and referral to dietetics professionals in the general practice setting
- Creator
- Mitchell, Lana
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2009
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Good nutrition is relevant for every person, with the delivery of nutrition advice vital for optimising the populations’ health, reducing risk of developing lifestyle diseases and managing the increasing numbers of people with chronic disease. The primary health care setting, specifically general practice, is an ideal location for the delivery of nutrition advice, as the majority of the population regularly accesses their GP; however, the barriers to the provision of nutrition advice and preventative care in this setting are extensive. Government initiatives have been developed to improve the delivery of lifestyle advice, including Lifescripts© and ‘Allied Health Services under Medicare’. However, it is unclear what the most effective means of delivering nutrition advice in the general practice setting are. Research in this thesis focused on evaluating the effectiveness of initiatives to increase and improve the provision of nutrition advice through the Lifescripts© implementation study, using General Practitioners (GPs), practice nurses (PNs), and patients. Baseline and follow-up questionnaires for GPs and PNs were developed around Lifescripts© training and implementation; the opinions of patients receiving Lifescripts© were also obtained using separate questionnaires and telephone interviews. Telephone interviews and an online survey were used to assess private practice (PP) dietetics professionals’ opinions. Dietitians Association of Australia (DAA) membership data and Medicare Enhanced Primary Care (EPC) Allied Health (AH) consultations were also analysed. This research was combined to form four individual chapters evaluating: patient access to nutrition advice by GPs, PNs; access to nutrition advice provided by dietetics professionals; implementation of nutrition advice by GPs and PNs, specifically via Lifescripts©; and implementation of nutrition advice by dietetics professionals, in particular via the EPC Program. GPs, PNs and dietetics professionals have key roles in providing nutrition advice in the general practice setting. GPs are the gatekeepers, believing nutrition is part of their role, and are trusted by patients. Practice nurses are approachable and supportive; however additional nutrition training is required. Dietetic professionals are the acknowledged nutrition experts with the training to provide individualised complex nutrition advice to patients. Lifescripts© are evidence based and should theoretically be effective in increasing the provision of nutrition advice. However, it is unclear if the implementation of Lifescripts in the general practice setting will be sufficient to overcome the well documented barriers to the implementation of nutrition advice in this setting, including time and lack of reimbursement. Poor recruitment of GP, PN and patient participants to the studies in this thesis, despite multiple recruitment strategies, highlights the difficulty of interventions into the general practice setting. ‘Allied Health Services under Medicare’ appears to be more effective, providing motivation for referral via structured pathways and reimbursement, utilises support from PNs, raises nutrition awareness via goal setting followed by expert nutrition advice. Initiatives to improve the delivery of nutrition advice need to involve GPs, PNs and dietetics professionals; have clear pathways for the provision of advice and referral; be reimbursable; and condition specific. GPs should raise nutrition awareness with patients, while PNs provide scripted nutrition advice using decision trees. Dietitian referral provides access to in-depth, personalised advice. It is essential that general practice patients have access to effective nutrition interventions, for without this, improvements in health outcomes will not be possible.
- Subject
- nutrition; general practice; dietitian; dietetics professional; general practitioner; practice nurse; Medicare; Lifescripts
- Identifier
- uon:6592
- Identifier
- http://hdl.handle.net/1959.13/804337
- Rights
- Copyright 2009 Lana Mitchell
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT02 | Thesis | 12 MB | Adobe Acrobat PDF | View Details Download |