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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
REVIEW

Nutrition beyond drugs and devices: a review of the approaches to enhance the capacity of nutrition care provision by general practitioners

Jennifer Crowley A C , Lauren Ball B , Clare Wall A and Michael Leveritt B
+ Author Affiliations
- Author Affiliations

A Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.

B School of Public Health and Griffith Health Institute, Griffith University, Gold Coast, Qld 4222, Australia.

C Corresponding author. Email: jennifercrowley099@gmail.com

Australian Journal of Primary Health 18(2) 90-95 https://doi.org/10.1071/PY11116
Submitted: 14 September 2011  Accepted: 6 December 2011   Published: 12 January 2012

Abstract

The prevention and management of chronic disease is a key priority for primary care services. Nutrition-related care is an integral feature of several best practice guidelines for management of chronic disease in the general practice setting. This paper critically reviews the international literature to enhance the nutrition knowledge, skills and overall capacity of GPs to provide nutrition care using examples from nutrition in medical education, continuing medical education, GP-centred and practice-setting approaches. The medical nutrition education approach provides an opportunity for linear translation between desired nutrition competencies and curriculum learning objectives, while that of continuing medical education allows for tailored nutrition education to increase nutrition competencies once a learning need is identified. The GP-centred approach focuses on the determinants of nutrition care provision by GPs as strategies for enhancing nutrition care delivery, whereas the practice setting approach aims to increase the nutrition-related exposure to patients through avenues independent of the GP. In the Australian and New Zealand context, the potential appropriateness of these approaches requires judicious consideration, as it is unlikely that one approach will comprehensively address this topic. Ongoing multifaceted evaluation of each approach is needed to ensure enhancement of GPs’ capacity to provide nutrition care by increasing nutrition knowledge and skills, and improving patient health outcomes.


References

Ajayi IO (2002) Patients’ waiting time at an outpatient clinic in Nigeria–can it be put to better use? Patient Education and Counseling 47, 121–126.
Patients’ waiting time at an outpatient clinic in Nigeria–can it be put to better use?Crossref | GoogleScholarGoogle Scholar | 12191535PubMed |

Australian Government (2003) ‘Clinical practice guidelines for the management of overweight and obesity: a guide for general practitioners.’ (Department of Health and Ageing: Canberra)

Australian Government (2006) ‘Enhanced primary care initiative.’ (Australian Institute of Health and Welfare: Canberra)

Australian Government (2011) ‘Lifescripts.’ (Department of Health and Ageing: Canberra) Available at http://www.health.gov.au/lifescripts [Verified 21 August 2011]

Australian Institute of Health and Welfare (2005) ‘Health system expenditure on chronic diseases.’ (Australian Institute of Health and Welfare: Canberra)

Australian Institute of Health and Welfare (2007) ‘Incidence and prevalence of chronic diseases.’ (Australian Institute of Health and Welfare: Canberra)

Australian Institute of Health and Welfare (2009) ‘General practice in Australia, health priorities and policies 1998–2008.’ (Australian Institute of Health and Welfare: Canberra)

Ball LE, Hughes RM, Leveritt MD (2010) Nutrition in general practice: role and workforce preparation expectations of medical educators. Australian Journal of Primary Health 16, 304–310.
Nutrition in general practice: role and workforce preparation expectations of medical educators.Crossref | GoogleScholarGoogle Scholar | 21138698PubMed |

Ball L, Hughes R, Leveritt M (2012) A study of health professionals’ views of the effectiveness of nutrition care in general practice. Nutrition & Dietetics (in press)

Bennett NL, Davis DA, Easterling WE, Friedmann P, Green JS, Koeppen BM, Masmanian PE, Waxman HS (2000) Continuing medical education: a new vision of the professional development of physicians. Academic Medicine 75, 1167–1172.
Continuing medical education: a new vision of the professional development of physicians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FovVSrsw%3D%3D&md5=e9a67738a862d72277954bf4a87da3f6CAS | 11112712PubMed |

Booth AO, Nowson CA (2010) Patient recall of receiving lifestyle advice for overweight and hypertension from their general practitioner. BMC Family Practice 11, 8

Britt H, Miller G, Knox S (2010) ‘General practice activity in Australia 2008–09.’ General Practice Series. (Australian Institute of Health and Welfare: Canberra)

Cant RP (2010) Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey. Australian Health Review 34, 197–203.
Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey.Crossref | GoogleScholarGoogle Scholar | 20497733PubMed |

Darer JD, Hwang W, Pham HH, Bass EB, Anderson G (2004) More training needed in chronic care: a survey of US physicians. Academic Medicine 79, 541–548.
More training needed in chronic care: a survey of US physicians.Crossref | GoogleScholarGoogle Scholar | 15165973PubMed |

Davis DA, Thomson MA, Oxman AD, Haynes RB (1995) Changing physician performance: a systematic review of the effect of continuing medical education strategies. Journal of the American Medical Association 274, 700–705.
Changing physician performance: a systematic review of the effect of continuing medical education strategies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MznvFWltg%3D%3D&md5=6ececcc636d1e39fcbce5a9f7f7ff14dCAS | 7650822PubMed |

Diabetes Australia, Royal Australian College of General Practitioners (2008) ‘Diabetes management in general practice.’ 14th edn. (Diabetes Australia: Sydney)

Dressler DD, Pistoria MJ, Budnitz TL, McKean SC, Amin AN (2006) Core competencies in hospital medicine: development and methodology. Journal of Hospital Medicine 1, 48–56.

Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming J (2008) Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. The Medical Journal of Australia 188, 29–32.

Fransen GAJ, Hiddink GJ, Koelen MA, van Dis SJ, Drenthen AJM, van Binsbergen JJ, van Woerkum CMJ (2008) The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands. Family Practice 25, I112–I115.
The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.Crossref | GoogleScholarGoogle Scholar |

Goodyear-Smith F, Whitehorn M, McCormick R (2003a) Experiences and preferences of general practitioners regarding continuing medical education: a qualitative study. The New Zealand Medical Journal 116, U399

Goodyear-Smith F, Whitehorn M, McCormick R (2003b) General practitioners’ perceptions of continuing medical education’s role in changing behaviour. Education for Health 16, 328–338.
General practitioners’ perceptions of continuing medical education’s role in changing behaviour.Crossref | GoogleScholarGoogle Scholar | 14741881PubMed |

Hark LA (2006) Lessons learned from nutrition curricular enhancements. The American Journal of Clinical Nutrition 83, 968S–970S.

Helman AD (1997) Nutrition and general practice: an Australian perspective. The American Journal of Clinical Nutrition 65, S1939–S1942.

Hiddink GJ, Hautvast J, Vanwoerkum CMJ, Fieren CJ, Vanthof MA (1995) Nutrition guidance by primary-care physicians − perceived barriers and low involvement. European Journal of Clinical Nutrition 49, 842–851.

Hiddink GJ, Hautvast J, vanWoerkum CMJ, Fieren CJ, vantHof MA (1997a) Consumers’ expectations about nutrition guidance: the importance of primary care physicians. The American Journal of Clinical Nutrition 65, S1974–S1979.

Hiddink GJ, Hautvast J, vanWoerkum CMJ, Fieren CJ, vantHof MA (1997b) Driving forces for and barriers to nutrition guidance practices of Dutch primary care physicians. Journal of Nutrition Education 29, 36–41.
Driving forces for and barriers to nutrition guidance practices of Dutch primary care physicians.Crossref | GoogleScholarGoogle Scholar |

Hiddink GJ, Hautvast J, van Woerkum CMJ, van’t Hof MA, Fieren CJ (1999) Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians. European Journal of Clinical Nutrition 53, S35–S43.
Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians.Crossref | GoogleScholarGoogle Scholar | 10406435PubMed |

Johansson K, Bendtsen P, Akerlind I (2005) Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation. European Journal of Public Health 15, 615–620.
Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation.Crossref | GoogleScholarGoogle Scholar | 16093300PubMed |

Kahn RF (2006) Continuing medical education in nutrition. The American Journal of Clinical Nutrition 83, 981S–984S.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine 346, 393–403.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38XhtVWqurc%3D&md5=dac171aaadd98d412902fac0c97d095cCAS | 11832527PubMed |

Kolasa KM (1999) Developments and challenges in family practice nutrition education for residents and practicing physicians: an overview of the North American experience. European Journal of Clinical Nutrition 53, S89–S96.
Developments and challenges in family practice nutrition education for residents and practicing physicians: an overview of the North American experience.Crossref | GoogleScholarGoogle Scholar | 10406445PubMed |

Krebs NF, Primak LE (2006) Comprehensive integration of nutrition into medical training. The American Journal of Clinical Nutrition 83, 945S–950S.

Kushner RF (1995) Barriers to providing nutrition counseling by physicians − a survey of primary-care practitioners. Preventive Medicine 24, 546–552.
Barriers to providing nutrition counseling by physicians − a survey of primary-care practitioners.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK287pslGksw%3D%3D&md5=ec5d0fbbc95979cf5fe2765a2dcfd091CAS | 8610076PubMed |

Lazarus K, Weinsier RL, Boker JR (1993) Nutrition knowledge and practices of physicians in a family-practice residency program: the effect of an education program provided by a physician nutrition specialist. The American Journal of Clinical Nutrition 58, 319–325.

Lindell KC, Adams KM, Kohlmeier M, Zeisel SH (2006) The evolution of Nutrition in Medicine, a computer-assisted nutrition curriculum. The American Journal of Clinical Nutrition 83, 956S–962S.

Maillet JO, Young EA (1998) Position of the American Dietetic Association: nutrition education for health care professionals. Journal of the American Dietetic Association 98, 343–346.

Mant D (1997) Effectiveness of dietary intervention in general practice. The American Journal of Clinical Nutrition 65, 1933S–1938S.

McKean SC, Budnitz TL, Dressler DD, Amin AN, Pistoria MJ (2006) How to use the core competencies in hospital medicine: a work for curriculum development. Journal of Hospital Medicine 1, 57–67.

Ministry of Health and the University of Auckland (2003) ‘Nutrition and the burden of disease: New Zealand 1997–2011. (Ministry of Health: Wellington)

Mitchell L (2009) Improving the provision of nutrition advice and referral to dietetics professionals in the general practice setting. Ph.D. Thesis, University of Newcastle, Newcastle.

Mitchell LJ, Capra S, MacDonald-Wicks L (2009) Structural change in Medicare funding: impact on the dietetics workforce. Nutrition & Dietetics 66, 170–175.
Structural change in Medicare funding: impact on the dietetics workforce.Crossref | GoogleScholarGoogle Scholar |

Mitchell LJ, Mac Donald-Wicks L, Capra S (2011) Nutrition avice in general practice: the role of general practitioners and practice nurses. Australian Journal of Primary Health 17, 202–208.

Monash University (2011) ‘Monash University Handbook 2011: MCM9202 Clinical Nutrition.’ Available at http://monash.edu/pubs/handbooks/units/MCM9202.html [Verified September 2011]

Murphy PS (1990) Family physicians’ opinions on nutrition after nutrition education. Journal of the American Dietetic Association 90, 1584–1586.

Myers P (1999) The objective assessment of general practitioners’ educational needs: an under-researched area? The British Journal of General Practice 49, 303–307.

National Health Priority Action Council (2006) ‘National chronic disease strategy.’ (Australian Government Department of Health and Ageing: Canberra)

National Public Health Partnership (2001) ‘Preventing chronic disease: a strategic framework.’ (Australian Government Department of Health and Ageing: Canberra)

Nicholas LG, Pond CD, Roberts DCK (2003a) Dietitian−general practitioner interface: a pilot study on what influences the provision of effective nutrition management. The American Journal of Clinical Nutrition 77, 1039S–1042S.

Nicholas LG, Pond CD, Roberts DCK (2003b) The role of the general practitioner and the dietitian in patient nutrition management. Asia Pacific Journal of Clinical Nutrition 12, 3–8.

Nutrition Task Force Project Team (1994) ‘Core curriculum for nutrition in the education of health professionals.’ (Department of Health: London)

Pomeroy SEM, Cant RP (2010) General practitioners’ decision to refer patients to dietitians: insight into the clinical reasoning process. Australian Journal of Primary Health 16, 147–153.
General practitioners’ decision to refer patients to dietitians: insight into the clinical reasoning process.Crossref | GoogleScholarGoogle Scholar |

Queensland Public Health Forum (2002) ‘Eat well Queensland: 2002–2012 Smart Eating for a healthier state.’ (Queensland Government: Brisbane)

Royal Australian College of General Practitioners (2007) ‘The RACGP curriculum for Australian general practice: chronic diseases.’ (The Royal Australian College of General Practitioners: Melbourne)

Steptoe A, Doherty S, Rink E, Kerry S, Kendrick T, Hilton S (1999) Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. British Medical Journal 319, 943–948.
Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MvktlyhsQ%3D%3D&md5=703a86236f7880f564b3652a0a761453CAS | 10514155PubMed |

Truswell AS (2000) Family physicians and patients: is effective nutrition interaction possible? The American Journal of Clinical Nutrition 71, 6–12.

Truswell AS, Hiddink GJ, Blom J (2003) Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities. The American Journal of Clinical Nutrition 77, 1089S–1092S.

van Dillen SME, Hiddink GJ (2008) A comparison of Dutch family doctors’ and patients’ perspectives on nutrition communication. Family Practice 25, I87–I92.
A comparison of Dutch family doctors’ and patients’ perspectives on nutrition communication.Crossref | GoogleScholarGoogle Scholar |

van Dillen SME, Hiddink GJ, Koelen MA, de Graaf C, van Woerkum CMJ (2004) Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study. European Journal of Clinical Nutrition 58, 1306–1313.
Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cvitlyrsA%3D%3D&md5=822d1c355907e5ffce6836a4debc7f6fCAS |

van Dillen SME, Hiddink GJ, Koelen MA, de Graaf C, van Woerkum CMJ (2006) Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs. Patient Education and Counseling 63, 74–83.
Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs.Crossref | GoogleScholarGoogle Scholar |

van Dillen SME, Hiddink GJ, Koelen MA, de Graaf C, van Woerkum CW (2008) Exploration of possible correlates of nutrition awareness and the relationship with nutrition-related behaviours: results of a consumer study. Public Health Nutrition 11, 478–485.
Exploration of possible correlates of nutrition awareness and the relationship with nutrition-related behaviours: results of a consumer study.Crossref | GoogleScholarGoogle Scholar |

Van Horn L (2006) The Nutrition Academic Award: brief history, overview, and legacy. The American Journal of Clinical Nutrition 83, 936S–940S.

Vetter ML, Herring SJ, Sood M, Shah NR, Kalet al (2008) What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. Journal of the American College of Nutrition 27, 287–298.

World Health Organization (2003) ‘Obesity and overweight: WHO global strategy on diet, physical activity and health.’ (World Health Organization: Geneva)

Worsley A, Lea E (2003) Consumers’ personal values and sources of nutrition information. Ecology of Food and Nutrition 42, 129–151.
Consumers’ personal values and sources of nutrition information.Crossref | GoogleScholarGoogle Scholar |

Young EA (1997) Nutrition education in US medical schools. The American Journal of Clinical Nutrition 65, 1558–1571.