School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.
J Hum Nutr Diet. 2023 Jun;36(3):920-931. doi: 10.1111/jhn.13079. Epub 2022 Sep 11.
Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors.
Semi-structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care.
Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter.
Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model.
不良饮食与多种慢性病有关。尽管医生可能很适合促进营养护理,但营养在国际医学教育中仍然是一个低优先级的问题。需要就营养能力达成共识,作为教育的基准,并建立监管框架以确保实施。本定性研究的目的是探索澳大利亚和英国一组医生提供营养护理的工作角色、态度、障碍和促进因素。
对澳大利亚和英国的初级保健医生/全科医生(n=14)和医学专家(n=8)进行半结构化访谈,以探讨提供营养护理的工作角色、态度、障碍和促进因素。
框架分析确定了五个关键主题:(1)支持医学营养护理的营养知识和技能,(2)营养教育的提供,(3)多学科和跨学科护理,(4)护理的系统障碍和促进因素,以及(5)范式转变的需要。参与者承认营养是医疗保健的重要组成部分,但认识到他们目前没有能力支持这种护理,他们认识到支持综合护理的系统存在局限性。参与者指出,营养既属于健康促进模型,也属于医疗/治疗模型,但他们目前仅在后者中工作。
参与者强调缺乏营养方面的知识和培训,没有这些知识和培训,改变是不可能的。必须相应增加对初级预防的投资,包括营养,这是从医疗模式的范式转变。