Date of Award

5-2018

Document Type

Thesis

College

College of Arts and Sciences

Degree Program

Human Nutrition

Degree Name

Master of Science

Thesis Advisor

Lauren R. Sastre

Committee Member

Danielle Nunnery

Committee Member

Duha Hamed

Keywords

Nutrition therapy, Primary care, Community health center, Dietitian, Diet therapy, Integrated care

Abstract

Suboptimal nutrition has been identified as the leading behavioral risk factor of morbidity and mortality from chronic diseases in the United States, yet approximately ten percent of all primary care visits included nutrition counseling by physicians in 2014 (Marczak, O’Rourke, & Shepard, 2016; GBD 2013 Risk Factor Collaborators, 2015; Rui, Hing, & Okeyode, 2015). The integration of registered dietitians into the primary care setting may serve as a potential solution to increasing the rates of delivery for nutrition counseling and improve patient outcomes. The objective of this study was to examine the incorporation and impact of a three-month nutrition education and counseling pilot program at a Community Health Center (CHC) in serving urban and rural populations in South Carolina. A retrospective chart review of the paper outpatient nutrition chart and electronic medical record (EMR) were conducted to assess the overall success of the 3- month pilot program and determine areas of improvement. Additionally, the medical providers at the CHC were surveyed to examine perceptions and satisfaction regarding the current practices related to nutrition counseling, perceived barriers to nutrition counseling, and the program and its delivery was conducted. A total of 93 patients were referred to the program with 53.8% (n=50) utilizing the services. Although there were no statistically significant changes for weight, body mass index (BMI), or hemoglobin A1c, downward trends were observed. Fisher’s exact tests indicated a significant association between number of visits and dyslipidemia/hyperlipidemia referrals (P=0.002) and between number of visits and age (P=0.0012). Patients without a referral for dyslipidemia were more likely to attend a single visit. In contrast, patients with a referral for ii dyslipidemia were more likely to attend multiple visits. Patients below the age of fifty years old were more likely to attend a single visit compared to adults above fifty years old (91.3% vs. 59.3%, respectively) (P=0.0012). Despite accounting for financial barriers to nutrition services, 46.2% of referred patients were never seen during the pilot program. Communication was the primary reasons these patients were never seen. Medical providers reported high satisfaction with the incorporation of nutrition services into their clinic. Future research is needed to determine intervention strategies that address both financial and nonfinancial barriers (e.g. cost, transportation, and communication) to integrating nutrition counseling and education into CHC and determine the influence of increased access to services on health outcomes.

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