Referrals to dietitians/nutritionists: A cross‐sectional analysis of Australian GP registrars’ clinical practice

Mulquiney, Katie; Tapley, Amanda; Driel, Mieke van; Morgan, Simon; Davey, Andrew; Henderson, Kim; Spike, Neil; Kerr, Rohan; Watson, Jane; Catzikiris, Nigel; Magin, Parker

doi:10.1111/1747-0080.12377

Cited by 25 publications

(27 citation statements)

References 19 publications

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“…In the general population, time constraints and lack of reimbursement were prominent themes recurrent in previous literature, which prevented GPs from efficiently providing lifestyle management. We report for the first time that similar barriers exist in general practice for PCOS [21,23,24,25,26]. Effective lifestyle counselling requires thorough and longer consultations.…”

Section: Discussionmentioning

confidence: 93%

“…Despite this, literature reports in the general population that GPs may not be fulfilling this role because of system-related and individual-related factors. These may include poor dissemination of guideline-based information to GPs, lack of funding, competing general practice interests, and time and pressure demands [21,23,24,25,26]. However, the perspective of GPs in providing weight and lifestyle management for women with PCOS has not been addressed in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives

et al. 2019

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Background: Weight and lifestyle management is advocated as the first-line treatment for polycystic ovary syndrome (PCOS) by evidence-based guidelines. Current literature describes both systems- and individual-related challenges that general practitioners (GPs) face when attempting to implement guideline recommendations for lifestyle management into clinical practice for the general population. The GPs’ perspective in relation to weight and lifestyle advice for PCOS has not been captured. Methods: Fifteen GPs were recruited to take part in semi-structured interviews. NVIVO software was used for qualitative analysis. Results: We report that GPs unanimously acknowledge the importance of weight and lifestyle management in PCOS. Practice was influenced by both systems-related and individual-related facilitators and barriers. Individual-related barriers include perceived lack of patient motivation for weight loss, time pressures, lack of financial reimbursement, and weight management being professionally unrewarding. System-related barriers include costs of accessing allied health professionals and unavailability of allied health professionals in certain locations. Individual-related facilitators include motivated patient subgroups such as those trying to get pregnant and specific communication techniques such as motivational interviewing. System-related facilitators include the GP’s role in chronic disease management. Conclusions: This study contributes to the understanding of barriers and facilitators that could be addressed to optimize weight and lifestyle management in women with PCOS in primary care.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives

et al. 2019

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“…However, most of these attempts appeared to be self-initiated with very little or no support by health professionals [33, 34]. The involvement of a dietitian is unlikely according to the low referral rate of PCOS patient to dietitians, resulting in women with PCOS seeking alternative sources of advice and support for lifestyle modification [34, 35]. It is known that certain behaviour change techniques are essential for successful lifestyle modification [36].…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study

et al. 2019

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BackgroundLifestyle modification targeting weight management is the first-line treatment for women with Polycystic Ovary Syndrome (PCOS) regardless of presenting symptoms. Women with PCOS are more likely to gain more weight compared with women without PCOS, which may be related to barriers in engaging in lifestyle modification. The aim of this study is to explore the experience of women with PCOS in weight management and to determine the facilitators and barriers to lifestyle modifications in women with PCOS.MethodsTen women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS. Discussions were audio-recorded and transcribed verbatim. Thematic analysis of the transcripts was conducted. Thematic analysis of the transcripts were conducted using the method of constant comparison.ResultsWomen in the current study attempted a wide range of weight loss interventions, but had difficulties losing weight and preventing weight regain. Women felt that having PCOS affected their ability to lose weight and to keep it off. Facilitators to lifestyle modification for weight management were reported as structured approaches such as having balanced meals and support by health professionals, peers, friends or family. Barriers to lifestyle changes in women with PCOS included logistical barriers such as time and cost, motivational barriers including tiredness or feeling unrewarded, environmental barriers such as not having access to safe places to exercise, emotional barriers such as having depressive and defeating thoughts, and relational barriers such as having unsupportive partner or prioritising children’s meal preferences.ConclusionsWomen with PCOS face a number of personal, environmental and social facilitators and barriers to lifestyle modification for weight loss. While many of these are also experienced by women without PCOS, women with PCOS face additional barriers in having low sense of self-confidence and high prevalence of negative thoughts which may impair their ability to maintain efforts in lifestyle modification over the long term. Future research should further explore the impact of the emotional and mental burden of PCOS on the management of weight and other aspects of PCOS. Future lifestyle intervention should also address the psychosocial aspect of PCOS.

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“…This study highlighted that the registrars’ rate of referral to a dietitian/nutritionist was comparable with that of GPs (Mulquiney et al . ), suggesting that referral for specialist dietary advice is not necessarily ‘front of mind’ for all doctors. If doctors are not directly providing dietary information and are not regularly referring patients to diet specialists, it perhaps is not surprising that information and support are sought from alternative sources such as the media and Internet (Cash et al .…”

Section: Doctors and Nutrition Advice: What Is Happening Now?mentioning

confidence: 99%

“…In an Australian study, Mulquiney et al . () reported that out of 145 708 consultations (by 1124 registrars), there were 227 190 problems/diagnoses and out of these only 587 (0.26%) resulted in a referral to a dietitian/nutritionist. The most common conditions for prompting a referral were obesity and type 2 diabetes.…”

Section: Doctors and Nutrition Advice: What Is Happening Now?mentioning

confidence: 99%

Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

et al. 2018

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Diet and nutritional status impact on health outcomes. The global rise of dietrelated non-communicable diseases plus the double burden of obesity and malnutrition means that it is imperative more than ever that all healthcare professionals are able to provide at least basic evidence-based nutrition advice. Improving an individual's diet requires more than just information provision, it requires consistent and long-term support to change and maintain new behaviours. Doctors acknowledge that nutrition plays a crucial role in health and agree that providing nutrition advice is part of their role. However, providing sufficiently detailed nutrition advice that is relevant to a patient's health goals, useful for the patient, and that results in measurable changes, is not common in practice settings. Numerous challenges and barriers have been identified for why doctors do not provide nutrition recommendations to their patients. A lack of nutrition education and training, time constraints during appointments, and patients who have access to an ever-growing body of nutrition and health information via the Internet and social media, together may explain why doctors tend not to include nutrition advice in their care plans. This paper outlines both short-and long-term strategies for improving doctors' engagement with nutrition interventions and collaborative working with dietitians in the context of collaborative care. Having doctors support and advocate for evidenced-based nutrition practice is a crucial element of the World Health Organization's Decade of Action on Nutrition achieving measurable success.

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Referrals to dietitians/nutritionists: A cross‐sectional analysis of Australian GP registrars’ clinical practice

Cited by 25 publications

References 19 publications

Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives

Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives

Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study

Are doctors nutritionists? What is the role of doctors in providing nutrition advice?

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