Dietitian Practices for Adult Outpatients With Hypercholesterolemia Referred by Physicians
The Minnesota Dietitian Survey
Robert B. Elson, MD;
Patricia L. Splett, RD, PhD;
Roberd M. Bostick, MD, MPH;
Dorothee Aeppli, PhD;
Marita Haberman, RD
Arch Fam Med. 1994;3(12):1073-1080.
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.
Main Outcome Measures
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.
From the Department of Family Practice and Community Health (Drs Elson and Bostick), Divisions of Epidemiology (Drs Splett and Bostick) and Biostatistics (Dr Aeppli), School of Public Health, University of Minnesota, Minneapolis; and Memorial Hospital, Cambridge, Minn (Ms Haberman). Dr Elson is now with the Department of Health Computer Sciences, University of Minnesota, Minneapolis.