Does the employment of an on‐site dietitian improve the uptake of dietetic care in general practice diabetes clinics?

Abstract

The results of a controlled trial of providing up-to-date on-site dietetic advice in primary health care diabetes clinics in a deprived FHSAarea in the North of England are described. Performance of these practices are compared with similar practices who utilise the existing open access service in the district. The study was part of a continuing audit cycle involving all practices with diabetes clinics in the district. Data were collected over one month. In the 10 practices that had an on-site dietitian, 191 patients were offered appointments. There was a 92% attendance rate; in the previous year 89% had a record of an HbA, , , 85% had a record of fundoscopy and 89% had seen the dietitian. By contrast, in the six practices who had open access to a centrally-based dietitian, 81 patients wereoffered an appointment, there was a 70% attendance rate (p<O.OOl), 74% had a record of an HbA,, (p<O.OOl), and 84% had a record of fundoscopy. Only 52% of this group had seen the dietitian (p<O.OOl). There was no significant difference in the HbA,, level as a percentage of Hb in either group.It is concluded that there is an association between the placing of a dietitian in general practice diabetes clinics and an improvement in the uptake of dietetic advice.

Increasing dietetic referrals: Perceptions of general practitioners, practice nurses and dietitians

“…Dietitians believed being located in a GP surgery made it easier for GPs to refer to them; however, it was acknowledged that it then may reduce referrals from GPs outside of the particular practice. Co‐location with GPs leads to easier and improved communication 10,11 which can lead to a greater recognition of being a vital member of the general practice team 9,11 . Dietitian and GP co‐location was also acknowledged to be more convenient for patients 9,11 .…”

“…9,11 Dietitian and GP co-location was also acknowledged to be more convenient for patients. 9,11 A GP surgery was the most common practice location for interview and survey dietitians with more than half of the participants working in this location. Contrary to this, research by Cant and Aroni (2008) show that the most common practice location for their participants was sole practice (49%), followed by a GP practice (29% of participants).…”

“…There is an acknowledged benefit of dietetic services being located within the general practice setting in improving patient care through better patient access and uptake of services 9,10 . Location of dietetic services within general practice can improve dietitians' relationships with GPs and are convenient for patients 9–11 . It is thought that improving collaboration between GPs and dietitians, made easier by co‐location, will encourage referrals and assist in maximising patients' health 12 …”

“…9,10 Location of dietetic services within general practice can improve dietitians' relationships with GPs and are convenient for patients. [9][10][11] It is thought that improving collaboration between GPs and dietitians, made easier by co-location, will encourage referrals and assist in maximising patients' health. 12 While dietitians are vital members of the primary healthcare team, unless referral occurs, the role of dietitians in the general practice setting can not be used to its full potential.…”

The dietitians challenge: the implementation of nutritional advice for people with diabetes*

“…, 2001). The smaller percentage in primary care reflects the lesser availability of dietetic expertise in primary care but may also be influenced by where the dietetic clinics are held; uptake of dietetic advice is greater if the dietitian works in the general practice diabetic clinic than if the service is provided separately on a central site (Bradshaw, 1994). In a survey of dietitians known to be engaged in the provision of diabetes care in the UK in 1997 only 69% reported that they were able to see more than half of newly diagnosed adult patients within 4 weeks and less than 50% were able to offer half or more of their patients an annual review (Nelson et al.…”