'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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Mayr, Hannah L
Savill, Holly
Law, Lynette
Campbell, Katrina L
Hill, Jan
Palmer, Michelle
Hickman, Ingrid J
Kelly, Jaimon T
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2022
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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.

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Nutrition & Dietetics

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© 2022 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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This publication has been entered in Griffith Research Online as an advanced online version.

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Nutrition and dietetics

cardiovascular diseases

diabetes mellitus

diet

health services

nutrition

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Mayr, HL; Savill, H; Law, L; Campbell, KL; Hill, J; Palmer, M; Hickman, IJ; Kelly, JT, '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 & Dietetics, 2022

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