Dietitians’ Perspectives on the Impact of Multidisciplinary Teams and Electronic Medical Records on Dietetic Practice for Weight Management

Publication: Canadian Journal of Dietetic Practice and Research
8 May 2019

Abstract

Purpose: To understand the perception of dietitians regarding the effects of multidisciplinary settings and Electronic Health Records (EHRs) on their dietetic practice for weight management.
Methods: Individual semi-structured interviews were conducted with 14 dietitians working in multidisciplinary settings in Ontario. All interviews were audio recorded and transcribed verbatim. Two researchers coded the data independently using a thematic analysis approach. All themes emerged inductively and were refined iteratively.
Results: Most dietitians believed that working in a multidisciplinary setting allowed for interprofessional collaboration and time-effective referrals. Multidisciplinary clinics were perceived to improve patient care due to convenient scheduling, consistent messaging, and ongoing support. However, some dietitians reported instances of conflicting approaches and beliefs regarding weight management across health professionals. Dietitians suggested ways to address these conflicting approaches through clinical meetings and education. EHRs were perceived to allow for collaboration through facilitated communication and knowledge exchange; however, lack of interoperability between EHR platforms across different types of health care settings was perceived to be a barrier for optimal care.
Conclusions: Overall, multidisciplinary settings were perceived to positively impact dietitians’ practices for weight management as they allow for interprofessional collaboration. Consistency in health messaging across health professionals should be emphasized through knowledge exchange.

Résumé

Objectif. Comprendre la perception des diététistes quant aux effets des environnements multidisciplinaires et des dossiers de santé électroniques (DSE) sur leur pratique de la diététique pour la gestion du poids.
Méthodes. Des entrevues individuelles semi-structurées ont été menées auprès de 14 diététistes travaillant dans des environnements multidisciplinaires en Ontario. Toutes les entrevues ont été enregistrées sur bande audio et transcrites textuellement. Deux chercheurs ont chiffré les données indépendamment en adoptant une approche d’analyse thématique. Tous les thèmes ont émergé inductivement et ont été épurés de manière itérative.
Résultats. La plupart des diététistes étaient d’avis que le fait de travailler dans un environnement multidisciplinaire permettait une collaboration interprofessionnelle, et des aiguillages rapides et efficaces. Les cliniques multidisciplinaires étaient perçues comme améliorant les soins aux patients grâce à une planification pratique, des messages cohérents et un soutien continu. Cependant, des diététistes ont signalé des cas de croyances et d’approches contradictoires concernant la gestion du poids chez les professionnels de la santé. Les diététistes ont suggéré des façons d’aborder ces approches contradictoires au moyen de réunions cliniques et de formation. Les DSE étaient perçus comme favorisant la collaboration grâce à la facilitation de la communication et de l’échange de connaissances; toutefois, le manque d’interopérabilité entre les plateformes de DSE dans différents types de milieux de soins de santé était perçu comme un obstacle à des soins optimaux.
Conclusions. Dans l’ensemble, les environnements multidisciplinaires étaient perçus comme ayant un impact positif sur les pratiques des diététistes pour la gestion du poids, car ils favorisent la collaboration interprofessionnelle. La cohérence des messages sur la santé entre les professionnels de la santé devrait être promue par l’échange de connaissances.

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Financial support: This study was supported by Telfer School of Management Research Grant (#147080), University of Ottawa.
Conflict of interest: The authors do not have any conflict of interest to declare.

References

1
Bray GA, Kim KK, and Wilding JPH. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715–23.
2
Brauer P, Connor G, Shaw E, Sing H, Bel N, Shan AR, et al. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. CMAJ. 2015;187(3):184–95.
3
Government of Canada. Primary health care transition fund; 2007 [cited 2019 Feb 1]. Available from: https://www.canada.ca/en/health-canada/services/primary-health-care/primary-health-care-transition-fund.html.
4
Dietitians of Canada. The dietitian workforce in Ontario primary health care survey report; 2015 [cited 2019 Feb 1]. Available from: http://www.dietitians.ca/Downloadable-Content/Public/PHC-survey-report-Sept2012.aspx.
5
Aboueid S, Bourgeault I, and Giroux I. Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada—a qualitative study. BMC Fam Pract. 2018;19(1):69.
6
Aboueid S, Pouliot C, Bourgault I, and Giroux I. A systematic review of interprofessional collaboration for obesity management in primary care, a focus on dietetic referrals. J Res Interprof Pract Educ. 2018;8(1):1–15.
7
Hartmann-Boyce J, Johns D, Jebb S, and Aveyard P. Effect of behavioural techniques and delivery mode on effectiveness of weight management: Systematic review, meta-analysis and meta-regression. Obes Rev. 2014;15(7):598–609.
8
Mitchell LJ, Ball LE, Ross LJ, Barnes KA, and Willians LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941–62.
9
Schaefer JT and Zullo MD. US registered dietitian nutritionists’ knowledge and attitudes of intuitive eating and use of various weight management practices. J Acad Nutr Diet. 2017;117(9):1419–28.
10
Schaefer JT and Magnuson AB. A review of interventions that promote eating by internal cues. J Acad Nutr Diet. 2014;114(5):734–60.
11
Hutchison B, Levesque J-F, Strumpf E, and Coyle N. Primary health care in Canada: systems in motion. Milbank Q. 2011;89(2):256–88.
12
Health Canada, Office of Health and the Information Highway. Toward electronic health records; 2001 [cited 2019 Feb 1]. Available from: http://publications.gc.ca/site/eng/102956/publication.html.
13
Reitz R, Common K, Fifield P, and Stiasny E. Collaboration in the presence of an electronic health record. Fam Syst Health. 2012;30(1):72–80.
14
Schoen C, Osborn R, Doty MM, Squires D, Peugh J, and Applebaum S. A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Aff. 2009;28(6):w1171–83.
15
Aboueid S, Bourgeault I, and Giroux I. Nutrition and obesity care in multidisciplinary primary care settings in Ontario, Canada: short duration of visits and complex health problems perceived as barriers. Prev Med Rep. 2018;10:242–7.
16
Denzin NK, Lincoln YS. Paradigms and perspectives in contention. In: Denzin NK, Lincolny YS, editors. The Sage handbook of qualitative research. 5th ed. Washington, DC: Sage Publications Inc.; 2018. p. 97–107.
17
Tong A, Sainsbury P, and Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
18
Hsieh H and Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
19
Tesch R. Qualitative research: analysis types and software tools. Bristol, PA: Falmer; 1990.
20
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. Thousand Oaks, CA: Sage; 1994.
21
Coffey A, Atkinson P. Making sense of qualitative data: complementary research strategies. Thousand Oaks, CA: Sage; 1996.
22
Johnson B. Examining the validity structure of qualitative research. Education. 1997;118(3):282–92.
23
Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage; 1985.
24
Patton, MQ. Qualitative research and evaluation methods. 2nd ed. Newbury Park, CA: Sage; 2002. p. 339–423.
25
Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, and Campbell-Scherer D. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study. Clin Obes. 2016;6(2):124–32.
26
Royall D, Brauer P, Atta-Konadu E, Dwyer J, Edwards M, Hussey T, et al. Eliciting provider and patient perspectives on new obesity management services in a team-based primary care organization. Can J Diet Pract Res. 2017;78(3):109–16.
27
Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P, and Roots A. Ten principles of good interdisciplinary team work. Hum Resour Health. 2013;11(1):19.
28
Wynn K, Trudeau JD, Taunton K, Gowans M, and Scott I. Nutrition in primary care: current practices, attitudes, and barriers. Can Fam Physician. 2010;56(3):109–16.
29
Claridge R, Gray L, Stubbe M, Macdonald L, Tester R, and Dowell AC. General practitioner opinion of weight management interventions in New Zealand. J Prim Health Care. 2014;6(3):212–20.
30
Ferrante JM, Piasecki AK, Ohman-Strickland PA, and Crabtree BF. Family physicians’ practices and attitudes regarding care of extremely obese patients. Obesity. 2009;17(9):1710–6.
31
Phelan S, Nallari M, Darroch FE, and Wing RR. What do physicians recommend to their overweight and obese patients? J Am Board Fam Med. 2009;22:115–22.
32
Kirk SF, Tytus R, Tsuyuki RT, and Sharma AM. Weight management experiences of overweight and obese Canadian adults: Findings from a national survey. Chronic Dis Inj Can. 2012;32(2):63–9.
33
Endevelt R and Gesser-Edelsburg A. A qualitative study of adherence to nutritional treatment: perspectives of patients and dietitians. Patient Prefer Adherence. 2014;8:147–54.
34
Torti J, Luig T, Borowitz M, Johnson JA, Sharma AM, and Campbell-Scherer DL. Erratum to: the 5As team patient study: patient perspectives on the role of primary care in obesity management. BMC Fam Pract. 2017;18:19.
35
Brown I, Thompson J, Tod A, and Jones G. Primary care support for tackling obesity: A qualitative study of the perceptions of obese patients. Br J Gen Pract. 2006;56(530):666–72.
36
Van Servellen G, Fongwa M, and Mockus D’Errico E. Continuity of care and quality care outcomes for people experiencing chronic conditions: a literature review. Nurs Health Sci. 2006;8(3):185–95.
37
Hark LA, Deen D, and Andj A. Position of the Academy of Nutrition and Dietetics: interprofessional education in nutrition as an essential component of medical education. J Acad Nutr Diet. 2017;117(7):1104–13.
38
Canadian Institute for Health Information. Chronic disease management in primary health care: a demonstration of EMR data for quality and health system monitoring; 2014 [cited 2019 Feb 1]. Available from: https://secure.cihi.ca/free_products/Burden-of-Chronic-Diseases_PHC_2014_AiB_EN-web.pdf.
39
Manca DP. Do electronic medical records improve quality of care?: yes. Can Fam Physician. 2015;61(10):846–47.
40
Chang F and Gupta N. Progress in electronic medical record adoption in Canada. Can Fam Physician. 2015;61(12):1076–84.

Information & Authors

Information

Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 81Number 1March 2020
Pages: 2 - 7

History

Version of record online: 8 May 2019

Authors

Affiliations

Stephanie Aboueid MSc, RD
Public Health and Health Systems, University of Waterloo, Waterloo, ON
Catherine Pouliot RD
Human Kinetics, University of Ottawa, Ottawa, ON
Billie Jane Hermosura MAdEd, MAN, RD
Education, University of Ottawa, Ottawa, ON
Ivy Bourgeault PhD
Health Systems Management, University of Ottawa, Ottawa, ON
Isabelle Giroux PhD, RD
Nutrition Sciences, University of Ottawa, Ottawa, ON

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