Kahn Daniel J, Hubbard Jane L, Dunn Stephen, Hoyt Alex
School of Nursing, MGH Institute of Health Professions, Boston, MA, USA.
Metabolism & Nutrition Research, Massachusetts General Hospital Translational & Clinical Research Center, Boston, MA, USA.
Adv Med Educ Pract. 2024 Oct 11;15:981-990. doi: 10.2147/AMEP.S459304. eCollection 2024.
Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition.
At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program.
In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05).
An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.
饮食/营养是糖尿病治疗的一线非药物疗法。初级保健提供者（PCP）很少提供饮食/营养咨询，他们在医学和高级实践提供者课程中的营养教育有限。本质量改进项目旨在通过提供一个关于糖尿病饮食/营养的在线继续医学教育（CME）项目，提高PCP对血糖控制不佳的糖尿病患者（糖化血红蛋白A1c≥8%）进行饮食/营养咨询的知识、态度和频率。
在新英格兰的一个社区健康中心，PCP参加了一个内部开发的50分钟在线CME直播课程，该课程向PCP传授了与糖尿病相关的当前饮食/营养指南和建议。在课程开始前和结束两周后，使用一个10道题的工具——糖尿病营养管理评估（NMDA）来评估知识。同样，使用患者护理中的营养调查（NIPS）的两个子量表来评估态度：常规护理中的营养和医生效能。对血糖控制不佳的糖尿病患者的病历进行审核，以评估PCP在CME课程前四周和后六周的饮食/营养咨询记录。
202年9月，29名PCP完成了CME课程。PCP在NMDA中的知识有了提高（差异为[X]%，p<0.001）。对NIPS的两个子量表的态度得分进行了评估，两者都有所改善，但只有[具体子量表]有显著改善（差异为15%，p<0.01）。教育项目后饮食/营养咨询的趋势有积极差异（p<0.05）。
一个在线CME项目提高了PCP对糖尿病饮食/营养的知识和态度，并改善了对血糖控制不佳的糖尿病患者的咨询实践。该教育项目为PCP提供了当前的护理标准指南/建议，他们在为糖尿病患者提供咨询时可以使用。PCP将从关于慢性病饮食/营养治疗的专门继续教育项目中受益。
