Streamlining nutritional care for the physician's office.
OBJECTIVE
Nutritional care needs are overlooked in clinical practice. We review nutritional needs and describe an approach for improving nutritional care in clinical practice.


METHODS
Data from a controlled trial and several population cohorts.


METHODS
Primary care practices and a population survey in New Hampshire and Vermont, USA.


METHODS
The controlled trial involved 1651 persons aged 70+years. The cohorts include information from 1879 persons aged 12+.


METHODS
All patients completed standard surveys which included information about nutritional needs. 22 practices participated in the trial.


RESULTS
The higher the BMI, the less healthy the population. 15 30% of patients report problems or concerns with eating/weight and nutrition. Patients with problems or concerns are often bothered by other health and social problems. Patients who have productive interactions with clinicians have improved nutritional care and are more likely to report help with eating problems (68% vs 86%; Odds ratio 5.0 (95% CI: 0.9-27.0).


CONCLUSIONS
Nutritional issues are common and complex. A productive provider-patient interaction can improve the nutritional care of patients. Essential elements for a productive interaction include an informed, educated patient and a provider (or clinical team) prepared to assess and manage the broad range of issues that are important to the patient. Technology facilitates necessary feedback between patient and provider.
The COOP project, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755-3862, USA. johnh.wasson@dartmouth.edu
J H
JH
Wasson
T
T
Ahles
D
D
Bazos
A
A
Bracken
J A
JA
Patterson
D J
DJ
Johnson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018849:Controlled Clinical Trials as Topic; D003625:Data Collection; D005194:Family Practice; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D009513:New Hampshire; D052756:Nutritional Sciences / Q000193:education; D009752:Nutritional Status; D010353:Patient Education as Topic; D012940:Social Problems; D014707:Vermont