'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service

Hannah L. Mayr; Holly Savill; Lynette Law; Katrina L. Campbell; Jan Hill; Michelle Palmer; Ingrid J. Hickman; Jaimon T. Kelly

doi:10.1111/1747-0080.12789

'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service

Hannah L. Mayr^*, Holly Savill, Lynette Law, Katrina L. Campbell, Jan Hill, Michelle Palmer, Ingrid J. Hickman, Jaimon T. Kelly

^*Corresponding author for this work

Bond University Nutrition and Dietetics Research Group

Research output: Contribution to journal › Article › Research › peer-review

9 Citations (Scopus)

Abstract

Aims: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service.

Methods: Semi-structured individual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post-acute community settings in a metropolitan health service in Australia. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.

Results: A total of 3 themes with 10 subthemes were identified. (a) 'Treatment prioritisation': important role of nutrition in risk factor management; competing priorities with complex patients; weight loss as a priority; and dietitians individualise. (b) 'Diverse roles in providing diet advice': a tension between nutrients, restrictions and diet quality; patients seek and trust advice from non-dietitians; and providing nutrition information materials crosses professions. (c) 'Dietitian access': variable integration and resourcing; access governed by clinician discretion and perceived patient interest; and bespoke application of referral pathways.

Conclusions: Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.

Original language	English
Pages (from-to)	307-319
Number of pages	13
Journal	Nutrition and Dietetics
Volume	80
Issue number	3
Early online date	11 Dec 2022
DOIs	https://doi.org/10.1111/1747-0080.12789
Publication status	Published - Jun 2023

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Cite this

Mayr, H. L., Savill, H., Law, L., Campbell, K. L., Hill, J., Palmer, M., Hickman, I. J., & Kelly, J. T. (2023). 'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service. Nutrition and Dietetics, 80(3), 307-319. https://doi.org/10.1111/1747-0080.12789

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title = "'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service",

abstract = "Aims: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service. Methods: Semi-structured individual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post-acute community settings in a metropolitan health service in Australia. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: A total of 3 themes with 10 subthemes were identified. (a) 'Treatment prioritisation': important role of nutrition in risk factor management; competing priorities with complex patients; weight loss as a priority; and dietitians individualise. (b) 'Diverse roles in providing diet advice': a tension between nutrients, restrictions and diet quality; patients seek and trust advice from non-dietitians; and providing nutrition information materials crosses professions. (c) 'Dietitian access': variable integration and resourcing; access governed by clinician discretion and perceived patient interest; and bespoke application of referral pathways. Conclusions: Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.",

author = "Mayr, {Hannah L.} and Holly Savill and Lynette Law and Campbell, {Katrina L.} and Jan Hill and Michelle Palmer and Hickman, {Ingrid J.} and Kelly, {Jaimon T.}",

note = "Funding Information: Metro South Health Study, Education and Research Trust Account (SERTA) Early Career Research Project Grant; National Heart Foundation of Australia, Grant/Award Number: 106081 Funding information Publisher Copyright: {\textcopyright} 2022 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.",

year = "2023",

month = jun,

doi = "10.1111/1747-0080.12789",

language = "English",

volume = "80",

pages = "307--319",

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Mayr, HL, Savill, H, Law, L, Campbell, KL, Hill, J, Palmer, M, Hickman, IJ & Kelly, JT 2023, ''We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service', Nutrition and Dietetics, vol. 80, no. 3, pp. 307-319. https://doi.org/10.1111/1747-0080.12789

'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service. / Mayr, Hannah L.; Savill, Holly; Law, Lynette et al.
In: Nutrition and Dietetics, Vol. 80, No. 3, 06.2023, p. 307-319.

Research output: Contribution to journal › Article › Research › peer-review

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AU - Mayr, Hannah L.

AU - Savill, Holly

AU - Law, Lynette

AU - Campbell, Katrina L.

AU - Hill, Jan

AU - Palmer, Michelle

AU - Hickman, Ingrid J.

AU - Kelly, Jaimon T.

N1 - Funding Information: Metro South Health Study, Education and Research Trust Account (SERTA) Early Career Research Project Grant; National Heart Foundation of Australia, Grant/Award Number: 106081 Funding information Publisher Copyright: © 2022 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.

PY - 2023/6

Y1 - 2023/6

N2 - Aims: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service. Methods: Semi-structured individual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post-acute community settings in a metropolitan health service in Australia. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: A total of 3 themes with 10 subthemes were identified. (a) 'Treatment prioritisation': important role of nutrition in risk factor management; competing priorities with complex patients; weight loss as a priority; and dietitians individualise. (b) 'Diverse roles in providing diet advice': a tension between nutrients, restrictions and diet quality; patients seek and trust advice from non-dietitians; and providing nutrition information materials crosses professions. (c) 'Dietitian access': variable integration and resourcing; access governed by clinician discretion and perceived patient interest; and bespoke application of referral pathways. Conclusions: Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.

AB - Aims: This study explored clinicians' perspectives on roles, practices and service delivery in the dietary management of coronary heart disease and type 2 diabetes in a public health service. Methods: Semi-structured individual interviews were conducted with 57 clinicians (21 nurses, 19 doctors, 13 dietitians and 4 physiotherapists) involved in the care of relevant patients across hospital and post-acute community settings in a metropolitan health service in Australia. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: A total of 3 themes with 10 subthemes were identified. (a) 'Treatment prioritisation': important role of nutrition in risk factor management; competing priorities with complex patients; weight loss as a priority; and dietitians individualise. (b) 'Diverse roles in providing diet advice': a tension between nutrients, restrictions and diet quality; patients seek and trust advice from non-dietitians; and providing nutrition information materials crosses professions. (c) 'Dietitian access': variable integration and resourcing; access governed by clinician discretion and perceived patient interest; and bespoke application of referral pathways. Conclusions: Time and resource constraints, variable access and referral to dietitians, and inconsistent advice were key challenges in the dietary management of coronary heart disease and type 2 diabetes. Models of care may be improved with greater investment and integration of dietitians, including to provide professional support across disciplines and disease specialties.

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'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service

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Nutrition for Chronic Disease and Disability: Research to improve health related quality of life and bring forward the under-represented voice

Research by Master of Nutrition and Dietetic Practice Students

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'We work in silos': Exploring clinicians' perspectives on the dietary management of coronary heart disease and type 2 diabetes in an Australian public hospital and community health service

Abstract

UN SDGs

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Nutrition for Chronic Disease and Disability: Research to improve health related quality of life and bring forward the under-represented voice

Research by Master of Nutrition and Dietetic Practice Students

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