General practitioners’ views on providing nutrition care to patients with chronic disease: a focus group study
Jennifer Crowley 1 , Lauren Ball 2 , Anne-Thea McGill 3 , Stephen Buetow 3 , Bruce Arroll 3 , Michael Leveritt 4 , Clare Wall 11 Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
2 Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld 4222, Australia
3 Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
4 School of Human Movement Studies, University of Queensland, Queensland, Australia
Correspondence to: Jennifer Crowley, School of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Email: j.crowley@auckland.ac.nz
Journal of Primary Health Care 8(4) 357-364 https://doi.org/10.1071/HC15048
Published: 21 December 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Nutrition care refers to practices conducted by health professionals to support patients to improve their dietary intake. General practitioners (GPs) are expected to provide nutrition care to patients for prevention and management of chronic disease.
AIM: This study explores GPs’ opinions regarding nutrition care provision to patients with chronic disease.
METHODS: An interpretive descriptive approach to qualitative research using seven semi-structured focus groups with 48 GPs in Auckland was used. Focus groups investigated how GPs felt about providing nutrition care; the perceived barriers to and support required for this care; the development of further nutrition knowledge and skills; and possible roles for Practice Nurses. Recorded interviews were transcribed verbatim and analysed using a thematic approach.
RESULTS: GPs indicated routine provision of basic nutrition care to patients with chronic disease, but perceived their limited consultation time and nutrition competence constrained their capacity to provide nutrition care. GPs felt they needed further information to provide culturally, socially and economically sensitive nutrition care. GPs displayed variable opinions on the benefits of developing their nutrition knowledge and skills, and the idea of Practice Nurses providing nutrition care.
CONCLUSIONS: Despite perceiving that nutrition care is important for patients with chronic disease and facing barriers to providing nutrition care, GPs appear reluctant to further develop their knowledge and skills and for Practice Nurses to provide this care. Strategies to enhance GPs’ nutrition-related self-efficacy, nutrition cultural competence and attitudes towards further training care may be warranted.
KEYWORDS: General practitioner; medical education; counselling; nutrition therapy; competence; attitude
References
[1] World Health Organization. Global status report on noncommunicable diseases 2010; 2011.[2] Ministry of Health and the University of Auckland. Nutrition and the burden of disease: New Zealand 1997–2011. Wellington, New Zealand: Ministry of Health; 2003.
[3] Coppell KJ, Kataoka M, Williams SM, et al. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ. 2010; 341 c3337
[4] Ball LE, Hughes RM, Leveritt MD. Nutrition in general practice: role and workforce preparation expectations of medical educators. Aust J Prim Health. 2010; 16 304–10.
| Nutrition in general practice: role and workforce preparation expectations of medical educators.Crossref | GoogleScholarGoogle Scholar |
[5] Royal New Zealand College of General Practitioners. Nutrition GPEP Syllabus. Royal New Zealand College of General Practitioners; 2013. [cited 2014 November 3]. Available from: www.rnzcgp.org.nz/assets/documents/Training-and-Beyond/Curriculum-Documents-December-2012/SyllabusNutrition.pdf.
[6] Ball L, Johnson C, Desbrow B, Leveritt M. General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease: a systematic review. J Prim Health Care. 2013; 5 59–69.
[7] Jackson AA. Human nutrition in medical practice: the training of doctors. Proc Nutr Soc. 2001; 60 257–63.
| Human nutrition in medical practice: the training of doctors.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mrnt1aqtg%3D%3D&md5=ee9dbc42ad055746c9764a7b69b88ab0CAS |
[8] Kolasa KM. “Images” of nutrition in medical education and primary care. Am J Clin Nutr. 2001; 73 1006–9.
| 1:CAS:528:DC%2BD3MXktlWiu7o%3D&md5=c344a0abdb232877675dc84716ac6665CAS |
[9] Interprofessional Educational Consortium Bringing nutrition education specialists into the mainstream: rationale for the Interprofessional Educational Consortium. Am J Clin Nutr. 1998; 68 894–8.
[10] Kushner RF. Barriers to providing nutrition counseling by physicians. Prev Med. 1995; 24 546–52.
| Barriers to providing nutrition counseling by physicians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK287pslGksw%3D%3D&md5=5aa6c1dffd255fc9b6f1d337b6f35e7aCAS |
[11] Hiddink GT, Hautvast JGAJ, Van Woerkum CMJ, et al. Driving forces for and barriers to nutrition guidance practices of Dutch primary care physicians. J Nutr Educ. 1997; 29 36–41.
| Driving forces for and barriers to nutrition guidance practices of Dutch primary care physicians.Crossref | GoogleScholarGoogle Scholar |
[12] Wynn K, Trudeau JD, Taunton K, et al. Nutrition in primary care. Can Fam Physician. 2010; 56 e109–16.
[13] Levine BS, Wigren MM, Chapman DS, et al. A national survey of attitudes and practices of primary-care physicians relating to nutrition: strategies for enhancing the use of clinical nutrition in medical education. Am J Clin Nutr. 1993; 57 115–9.
| 1:STN:280:DyaK3s7kt1Kqsg%3D%3D&md5=2492a3f64e5d73be55b9fbc03583376cCAS |
[14] Hopper D, Barker M. Dietary advice, nutrition knowledge and attitudes towards nutrition in primary care. J Hum Nutr Diet 1995; 8 279–86.
| Dietary advice, nutrition knowledge and attitudes towards nutrition in primary care.Crossref | GoogleScholarGoogle Scholar |
[15] Cumming J, Mays N, Gribben B.. Reforming primary healthcare: is New Zealand’s primary health care strategy achieving its early goals? Aust NZ Health Policy 2008; 5
| Reforming primary healthcare: is New Zealand’s primary health care strategy achieving its early goals?Crossref | GoogleScholarGoogle Scholar |
[16] New Zealand Medical Association. An analysis of the New Zealand general practitioner workforce – update 2009. Wellington, New Zealand: New Zealand Medical Association; 2008.
[17] Crowley J, Ball L, Han D, et al. Doctors’ attitudes and confidence towards providing nutrition care in practice: comparison of New Zealand medical students, GP registrars and GPs. J Prim Health Care. 2015; 7 244–50.
[18] Claridge R, Gray L, Stubbe M, et al. General practitioner opinion of weight management interventions in New Zealand. J Prim Health Care. 2014; 6 212–20.
[19] Sandelowski M. Focus on research methods. Whatever happened to qualitative description? Res Nurs Health. 2000; 23 334–40.
| Focus on research methods. Whatever happened to qualitative description?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvhsFCmtw%3D%3D&md5=631a973b32c1b63a9c58d65e50085c2dCAS |
[20] Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurs Health. 2010; 33 77–84.
[21] Huston SA, Hobson EH. Using focus groups to inform pharmacy research. Res Social Adm Pharm. 2008; 4 186–205.
| Using focus groups to inform pharmacy research.Crossref | GoogleScholarGoogle Scholar |
[22] Parsons M, Greenwood J. A guide to the use of focus groups in health care research: part 1. Contemp Nurse. 2000; 9 169–80.
| A guide to the use of focus groups in health care research: part 1.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD387itFChsg%3D%3D&md5=07039c2ad254a053e806e7e5ed42622cCAS |
[23] Ball L, Desbrow B, Leveritt M. An exploration of individuals’ preferences for nutrition care from Australian primary care professionals. Aust J Prim Health. 2014; 20 113–20.
| An exploration of individuals’ preferences for nutrition care from Australian primary care professionals.Crossref | GoogleScholarGoogle Scholar |
[24] Joshy G, Lawrenson R, Simmons D. Retention of patients in the ‘Get Checked’ free annual diabetes review program in New Zealand. N Z Med J. 2008; 121 35–44.
[25] Gamblen W, Schamehorn S, Crustolo A, Hussey T, Kates N, Ackerman S. The registered dietitian in primary care: the Hamilton experience. Can J Diet Pract Res. 2007; 68 81–5.
| The registered dietitian in primary care: the Hamilton experience.Crossref | GoogleScholarGoogle Scholar |
[26] Maryon-Davis A. Weight management in primary care: how can it be made more effective? Proc Nutr Soc. 2005; 64 97–103.
| Weight management in primary care: how can it be made more effective?Crossref | GoogleScholarGoogle Scholar |
[27] Kris-Etherton PM, Akabas SR, Douglas P, et al. Nutrition competencies in health professionals’ education and training: a new paradigm. Adv Nutr. 2015; 6 83–7.
| Nutrition competencies in health professionals’ education and training: a new paradigm.Crossref | GoogleScholarGoogle Scholar |
[28] Laurant M, Hermens R, Braspenning J, et al. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews 2005; Art No. CD001271
| Substitution of doctors by nurses in primary care.Crossref | GoogleScholarGoogle Scholar |
[29] Martin L, Desbrow B, Leveritt M, Ball L. The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease. Fam Pract. 2014; 31 201–8.
| The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.Crossref | GoogleScholarGoogle Scholar |
[30] Cass S, Ball L, Leveritt M. Australian practice nurses’ perceptions of their role and competency to provide nutrition care to patients living with chronic disease. Aust J Prim Health. 2014; 20 203–8.
| Australian practice nurses’ perceptions of their role and competency to provide nutrition care to patients living with chronic disease.Crossref | GoogleScholarGoogle Scholar |
[31] Hoare KJ, Mills J, Francis K. The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. J Adv Nurs. 2012; 68 963–80.
| The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review.Crossref | GoogleScholarGoogle Scholar |
[32] Carryer J, Snell H, Perry V, Hunt B. Long-term conditions care in general practice settings: patient perspectives. N Z Fam Physician. 2008; 35 319–23.
[33] Howatson A, Wall C. Position paper and systematic review. Contribution of dietitians in the primary care health workforce. Wellington: Dietitians New Zealand; 2014.
[34] Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: a cost effective analysis. J Epidemiol Community Health. 1999; 53 311–6.
| Nutritional counselling in general practice: a cost effective analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzisVylsw%3D%3D&md5=044c89d032bef109c8d989b4c61e4c5cCAS |
[35] The Royal New Zealand College of General Practitioners. 2014 RNZCGP workforce survey. Wellington, New Zealand: The Royal New Zealand College of General Practitioners; 2014.