Literature Collection

BackgroundMany Americans look to primary care physicians (PCPs) for education on how to lead healthier lives. Understanding the duration of nutrition education necessary for PCPs to produce a behavioral impact may inform physician appointment recommendations.AimTo assess whether the duration of nutrition education given by PCPs correlates with changes in dietary behavior, or secondarily, health status, among patients without complex chronic disease.MethodsPRISMA-ScR guidelines were followed for this scoping review. Inclusion criteria of our review included: PCPs providing nutrition/dietary education, dietary intervention, adult participants, original research, manuscript published in English, study conducted in the U.S., and published 2011-present. Databases searched: PubMed, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Exclusion criteria included: patients experiencing complex chronic health conditions. Data extracted included: study design, description of PCP dietary intervention, length of nutrition education, and general directions of health/behavioral outcomes.ResultsThree reviewed papers studying behavioral interventions that included PCP nutrition education yielded a positive impact on patient outcomes such as dietary behavior and/or weight loss, though only two of the three studies yielded results that achieved statistical significance.ConclusionThere appears to be an important role for nutrition education in the primary care setting. However, our review exposed great need for further research on the specific association between duration of nutrition counseling and resulting changes in dietary and health outcomes.

BACKGROUND: Burnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being. OBJECTIVE: To examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levels DESIGN: Analysis of 286 cross-sectional surveys in 2012 (n = 171) and 2013 (n = 115) PARTICIPANTS: 210 PCPs in one VA region MAIN MEASURES: Outcomes were PCP-reported burnout (Maslach Burnout Inventory emotional exhaustion subscale), and secondarily, job satisfaction. Two independent variables represented mental health integration: (1) PCP-specialty communication rating and (2) proportion of clinic patients who saw integrated specialists. Using multilevel regression models, we examined PCP-reported burnout (and job satisfaction) and mental health integration, adjusting for PCP characteristics (e.g., gender), PCP ratings of team functioning (communication, knowledge/skills, satisfaction), and organizational factors. KEY RESULTS: On average, PCPs reported high burnout (29, range = 9-54) across all VA healthcare systems. In total, 46% of PCPs reported "very easy" communication with mental health; 9% of primary clinic patients had seen integrated specialists. Burnout was not significantly associated with mental health communication ratings (β coefficient = - 0.96, standard error [SE] = 1.29, p = 0.46), nor with proportion of clinic patients who saw integrated specialists (β = 0.02, SE = 0.11, p = 0.88). No associations were observed with job satisfaction either. Among study participants, PCPs with poor team functioning, as exhibited by low team communication ratings, reported high burnout (β = - 1.28, SE = 0.22, p < 0.001) and low job satisfaction (β = 0.12, SE = 0.02, p < 0.001). CONCLUSIONS: As currently implemented, primary care and mental health integration did not appear to impact PCP-reported burnout, nor job satisfaction. More research is needed to explore care model variation among clinics in order to optimize implementation to enhance PCP well-being.