Table of Contents

Background: Dietitians of Canada has endorsed the Principles and Framework for Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) created by the EICP Initiative. The Initiative focused on the conditions required for health professionals to work together in the most effective and efficient way, so that they can produce the best health outcomes for individuals and their families – the patients, clients, and consumers of our national health system. The Initiative was spearheaded by a Steering Committee of 11 national health professional organizations, and brought together leaders, health professionals, and key stakeholders in Canada's primary health care system in a change process designed to facilitate more interdisciplinary collaboration. Principles and Framework: In the context of the EICP Initiative, the Principles are values shared by stakeholders. They are critical to the establishment of collaboration and teamwork to achieve the best health outcomes. The elements of the Principles are patient/client engagement, a population health approach, the best possible care and services, access, trust and respect, and effective communication. The Framework builds upon these Principles and is composed of the structural and process elements required to support collaborative primary health care. The elements of the Framework are health human resources, funding, liability, regulation, information and communications technology, management and leadership, and planning and evaluation. Conclusions: The Boards of Directors of the ten health professions leading the EICP Initiative agreed upon the values and key structural and process elements that need to be put in place to enhance interdisciplinary collaboration in Primary Health Care in Canada. Dietitians of Canada will continue to seek opportunities to further the change process started by EICP. Approximately 40 research papers and a toolkit to help primary heath care providers work together have been produced.

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Purpose: Primary health care reform presents new opportunities for registered dietitians (RDs) to contribute to health promotion and disease prevention in family practices. Since this is an emerging area of RD practice, a health promotion specialist was contracted to conduct a needs assessment and develop a plan for implementing nutrition-focused healthy lifestyle activities. Methods: The needs assessment was conducted as part of an Ontario-based demonstration project in three Family Health Networks (FHNs). Results: The needs assessment revealed a lack of agreement about what types of activities should be undertaken, a lack of information on the population's needs, a lack of coordination with other agencies in the community, and barriers of time and resources. The health promotion specialist recommended that health care team members in each FHN develop a shared understanding of their goals, and undertake the entire planning and evaluation cycle. Specific strategies were suggested to increase awareness, to provide health education, and to improve environmental support. Conclusions: A significant need exists for conceptual development, planning, testing, and evaluation of disease prevention and health promotion in family physician-based primary health care organizations. The findings may be useful to others interested in increasing the focus on health promotion and disease prevention in such practices.

Purpose: Primary health care (PHC) reform, especially efforts to implement interdisciplinary teams, has implications for dietetic practice. A consistent, clear vision of the registered dietitian’s (RD’s) role in PHC is needed to develop a successful advocacy agenda. Methods: The Dietitians of Canada (DC) Central and Southern Ontario Primary Health Care Action Group organized a four-step process to engage dietitians in developing an advocacy agenda for RD PHC services in Ontario. Two facilitated workshops brought together dietitian opinion leaders to enhance the understanding of current roles, find common ground, and develop a shared vision. All DC members were invited to review the draft vision, and feedback was integrated into a revised vision. Results: Registered dietitians saw PHC reform through many lenses, and were uncertain about how reforms would affect their practices. In a national review, the majority of reviewers (approximately 85% of 270) supported the draft vision; additional clarity was needed on resources and the breadth of services that RDs would provide. Conclusion: Development of a PHC vision for RDs should be helpful in advocating for dietitian services in PHC.