Integrating a diet quality screener into a cardiology practice: assessment of nutrition counseling, cardiometabolic risk factors and patient/provider satisfaction

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>We assessed factors related to the integration of an office-based diet quality screener: nutrition counselling, cardiometabolic risk factors and patient/physician satisfaction.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We evaluated the impact of a 10-item diet quality measure (self-rated diet quality question and a 9-item Mediterranean Diet Score (MDS)) prior to the cardiology visit on assessment of nutrition counselling, cardiometabolic risk factors and patient/provider satisfaction. Study staff trained the nine participating physicians on the purpose and use of the screener. To assess physician uptake of the diet quality screener, we reviewed all charts having a documented dietitian referral or visit and a 20% random sample of remaining participants that completed the screener at least once to determine the proportion of notes that referenced the diet quality screener and documented specific counselling based on the screener.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Between December 2017 and August 2018, 865 patients completed the diet quality screener. Mean age was 59 (SD 16) years, 54% were male and mean body mass index was 27.4 (SD 6.0) kg/m<jats:sup>2</jats:sup>. Almost one-fifth (18.5%) of participants rated their diet as fair or poor, and mean MDS (range 0–9) was moderate (mean 5.6±1.8 SD). Physicians referred 22 patients (2.5%) to a dietitian.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Integrating the screener into the electronic health record did not increase dietitian referrals, and improvements in screener scores were modest among the subset of patients completing multiple screeners. Future work could develop best practices for physicians in using diet quality screeners to allow for some degree of standardisation of nutrition referral and counselling received by the patients.</jats:p></jats:sec>

Training Medical Students in Diet Assessment and Brief Counseling

“…Previous work from our group also includes creation and testing of a diet assessment tool 15 among family medicine residents (Johnston EA, Training Family Medicine Residents in Diet Assessment, under review), and integration of a dietary screener in a cardiovascular prevention practice. 16 The focus of our collaborations is the improvement of nutrition training and resources for physicians and future physicians and this work allowed us to measure the impact of use of the ebook on a larger scale.…”

The feasibility and acceptability of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in research: findings from the Lifestyle in Later Life – Older People’s Medicine (LiLL-OPM) study

“…Participants were also asked to self-rate their overall diet ("In general, how healthy is your overall diet?") [21]. Appetite was assessed using the Simpli ed Nutritional Appetite Questionnaire (SNAQ) [22] We characterised habitual physical activity in two ways: rstly, using the Rapid Assessment of Physical Activity (RAPA) questionnaire [23] and secondly using wrist-worn accelerometery.…”

Integrating Diet Screening Into Routine Clinical Care: The Time Is Now

“…It is encouraging to see progress in the development and validation of rapid diet screener tools. However, with the emergence of this tool and others, 17 further research is needed to assess implementation, including possible unintended consequences. For example, a diet screener tool may have research validity but not be adequately evaluated for the practical aspects of inclusion in the clinical setting.…”