A new scientific statement from the American Heart Association (AHA) incorporates a rapid dietary screening tool into regular primary care visits to inform dietary counseling and electronic health records for patients in all healthcare settings ( EHR) platform is recommended.
The statement authors evaluated 15 existing screening tools and did not recommend a specific tool, but some tools have strengths and weaknesses that make them the most popular among clinicians and other professionals. Encourages “Important Conversations” to reach critical tools Suitable for use in certain healthcare environments.
“Since suboptimal diets are the greatest risk factor for cardiovascular disease, it is important for clinicians to incorporate discussion of dietary patterns into their routine preventative care appointments,” statement group chair Maya Vadevello, PhD, RD said theheart.org | Medscape Cardiology.
“I also wanted to see that screening tools could be integrated into the EHR to be used for clinical support and to track and monitor a patient’s dietary pattern over time,” says Vadiveloo, an associate professor of nutrition and food science. He says. School of Health Sciences, Kingston, Rhodestone University
The statement is Published online August 7 Circulation: Cardiovascular quality and outcome.
Competing demand
Poor diets “outweigh all other mortality risk factors, accounting for 11 million deaths worldwide and about 50% of cardiovascular disease (CVD) deaths,” the authors write. ..
“Overall health” because diets that are low in fruits, vegetables, whole grains and high in red and processed meats, sugars, sodium, and total energy are “major determinants” of the risk of CVD and other conditions. Strategies to promote healthy eating patterns’Reducing the risk of chronic illness is of modern importance. “
The authors say that most clinicians and other health care team members “currently do not evaluate or counsel patients about food and drink intake during their daily routine”. I am.
Reasons for this include lack of training and knowledge, inadequate time, inadequate integration of nutritional services into the healthcare environment, inadequate reimbursement, and “competitive demands during visits”.
Vadiveloo said rapid evidence-based screening tools can go a long way in helping to overcome these barriers.
“When primary care practitioners discuss their diet with patients, studies have shown that patients are receptive, but clinical workloads are already very compacted, making them an alternative to routine preventive care promises.” It also proves difficult to add,” she said. “So we wanted to see if we already had screening tools that reflect the best science that is valid, reliable, and promise to be easily incorporated into different types of clinical settings. “
Top pick
The authors have established “theoretical and practice-based criteria” of optimal dietary screening tools for use in the adult population (20-75 years). The tool had to do the following:
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Developed or used in clinical settings in the last 10 years.
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Reliable and effective, based on evidence.
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Evaluate overall dietary patterns rather than focusing on a single food or nutrient.
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You can complete and score during administration without any special knowledge or software.
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We provide practical next steps and patient support.
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You can track and monitor changes in your diet over time.
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Be concise. And
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Helps manage chronic diseases.
Of the 15 tools reviewed, the three that met the most theoretical and practice-based relevance criteria Mediterranean Diet Compliance Screener (MEDAS) And that variationChanged, shortened Rapid meal evaluation (REAP) of participants, And modified version Start conversation tool.. But the authors Powell and Greenberg screening tools It was “the most time-consuming work”.
One size does not fit all
Vadiveloo emphasized that “a single tool is not suitable for all clinic settings, so I want clinicians to explain what works in a particular setting.”
For example, do screening tools need to be completed by a clinician, a member of a healthcare team, or a patient? Benefits of tools completed by clinicians or team members include real-time information gathering. This information can be used in shared decision making during encounters, and the screen is completed by the clinician for added reliability. On the other hand, clinicians may not be able to prioritize the administration of screening tools during short clinical encounters.
The advantage of the patient-completed tool via the EHR portal is that the patient is less at risk of judgment by the clinician or health care professional and the screen is completed at the patient’s convenience. The disadvantage is limited access to underserved populations, which may be less reliable than clinician-managed tools.
“While having staff that can be managed by multiple members of a medical team to reduce the demands of clinicians is advantageous in the presence of such staff, in other settings self-management is better. I tried to keep it open because it could be-I’m done.”
“Ideal platform”
“The EHR is an ideal platform to encourage clinicians and other members of the healthcare team to collect dietary data and provide dietary advice to patients,” the authors write.
EHR enables the secure storage of data and the point-of-care access to these data when needed. These are also important for documentation purposes.
The author states that the use of “countless EHR platforms and platform versions” created “technical challenges”. They recommend a “standardized approach” for sending health data.
They also recommend that end users test a rapid diet screening prototype before implementing it in a particular clinic. “By pre-collecting these data, we can improve the uptake of real-world applications,” they say.
Vadiveloo added that nutrition counseling can be done by doctors as well as multiple members of the healthcare team, including dietitians. Or you may need to refer the patient to a dietitian for counseling and follow-up.
The authors conclude by characterizing the AHA statement as a “call for action”… by encouraging important conversations between clinicians, individuals with diet/lifestyle expertise, It is designed to accelerate efforts to make quality assessment an integral part of office-based care delivery. Information technology expert. “
Vadiveloo does not disclose any financial relationships involved. The disclosures of the other authors appear in the original paper.
Circ Cardiovasc Qual results. Published online August 7, 2020. Overview
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