Elson R B, Splett P L, Bostick R M, Aeppli D, Haberman M
Department of Family Practice and Community Health, School of Public Health, University of Minnesota, Minneapolis.
Arch Fam Med. 1994 Dec;3(12):1073-80. doi: 10.1001/archfami.3.12.1073.
To characterize the physician-to-dietitian referral process and dietitian practice patterns and opinions related to adult outpatients with hypercholesterolemia.
Cross-sectional mail survey.
Minnesota dietitians who treat adult outpatients referred by physicians for hypercholesterolemia.
Proportion of patients for whom background information or specific diet instructions were provided by referring physicians and for whom follow-up was recommended and dietary fat content calculated by the dietitians.
Completed questionnaires were returned by 216 of 267 eligible dietitians (81% response rate). Respondents saw, on average, 31 referred patients per month, 31% of whom were referred for hypercholesterolemia, 31% for type II diabetes mellitus, and 24% for obesity. For patients referred for hypercholesterolemia, background information was provided by physicians 37% of the time, and specific diet instructions 15% of the time. One or more follow-up visits by the dietitians were recommended for 42% of patients referred for hypercholesterolemia, compared with 60% and 70% of patients referred for diabetes and obesity, respectively. The average number of additional visits within 6 months of the initial consultation recommended by dietitians was 2.0 for patients referred for hypercholesterolemia, 3.5 for patients referred for diabetes, and 6.7 for patients referred for obesity, and the number of visits that occurred was half or less than that recommended. Dietary fat content was calculated by the dietitians for only 25% of patients referred for hypercholesterolemia.
For adult outpatients referred to dietitians for hypercholesterolemia, relevant patient information is usually not provided by referring physicians, the number of follow-up visits is well below what would reasonably be expected to produce significant and sustained eating behavior change, and calculation of dietary fat content is generally not done. More research is needed to determine appropriate nutrition intervention protocols for these patients.
描述医生向营养师转诊成人高胆固醇血症门诊患者的过程以及营养师的实践模式和观点。
横断面邮寄调查。
明尼苏达州治疗由医生转诊的成人高胆固醇血症门诊患者的营养师。
转诊医生提供背景信息或具体饮食指导的患者比例、建议进行随访的患者比例以及营养师计算的饮食脂肪含量。
267名符合条件的营养师中有216名返回了完整问卷（回复率81%）。受访者平均每月接待31名转诊患者，其中31%因高胆固醇血症转诊，31%因II型糖尿病转诊，24%因肥胖转诊。对于因高胆固醇血症转诊的患者，医生37%的情况下会提供背景信息，15%的情况下会提供具体饮食指导。42%因高胆固醇血症转诊的患者被建议由营养师进行一次或多次随访，相比之下，因糖尿病转诊的患者这一比例为60%，因肥胖转诊的患者为70%。营养师建议在初次咨询后6个月内，因高胆固醇血症转诊的患者平均额外就诊次数为2.0次，因糖尿病转诊的患者为3.5次，因肥胖转诊的患者为6.7次，而实际就诊次数仅为建议次数的一半或更少。营养师仅为25%因高胆固醇血症转诊的患者计算了饮食脂肪含量。
对于转诊给营养师的成人高胆固醇血症门诊患者，转诊医生通常不提供相关患者信息，随访次数远低于合理预期能产生显著且持续饮食行为改变的次数，且通常不计算饮食脂肪含量。需要更多研究来确定针对这些患者的适当营养干预方案。
