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General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process

Pomeroy, Sylvia E.M. and Cant, Robyn P. 2010, General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process, Australian journal of primary health, vol. 16, no. 2, pp. 147-153, doi: 10.1071/PY09024.

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Title General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process
Author(s) Pomeroy, Sylvia E.M.
Cant, Robyn P.
Journal name Australian journal of primary health
Volume number 16
Issue number 2
Start page 147
End page 153
Publisher Australian Journal of Primary Health, Australian Institute for Primary Care and School of Public Health, La Trobe University
Place of publication Bundoora, Vic.
Publication date 2010
ISSN 1448-7527
1836-7399
Keyword(s) nutrition
Summary The aim of this project was to describe general practitioners’ (GPs’) decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients’ referral. There was no association between GPs’ sex, age or hours worked per week and referral factors. We conclude that a GP’s judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients’ nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.
Language eng
DOI 10.1071/PY09024
Field of Research 110199 Medical Biochemistry and Metabolomics not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2010, CSIRO Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30030898

Document type: Journal Article
Collection: School of Exercise and Nutrition Sciences
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Created: Wed, 20 Oct 2010, 09:36:44 EST

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