Barriers and facilitators of nutritional intervention after hip fracture in integrated care as perceived by the different health care professionals: A qualitative interview study

  • José J.L. Breedveld-Peters
    Correspondence
    Corresponding author. Tel.: +31 43 3882333; fax: +31 43 3884128.
    Affiliations
    Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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  • Petronella L.M. Reijven
    Affiliations
    Department Clinical Dietetics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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  • Caroline E. Wyers
    Affiliations
    Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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  • Angela A. Hendrikx
    Affiliations
    Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands

    Present address: Department of Dietetics, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
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  • Aart D. Verburg
    Affiliations
    Department of Orthopaedic Surgery, Orbis Medical Centre, PO Box 5500, 6130 MB Sittard, The Netherlands
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  • Jos M.G.A. Schols
    Affiliations
    Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands

    Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands

    Vivre (a long-term care organization), PO Box 241, 6200 AE Maastricht, The Netherlands
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  • Martin H. Prins
    Affiliations
    Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands

    Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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  • Trudy van der Weijden
    Affiliations
    Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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  • Pieter C. Dagnelie
    Affiliations
    Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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Published:August 06, 2012DOI:https://doi.org/10.1016/j.clnme.2012.07.001

      Summary

      Background & aims

      Nutritional intervention in elderly hip fracture patients is important, but implementation is difficult. In order to identify barriers and facilitators for implementation, we conducted a qualitative interview study within the setting of a multicentre RCT, and evaluated the experiences of health care professionals with an applied intensive nutritional intervention comprised of dietetic counselling and oral nutritional supplements.

      Methods

      Individual semi-structured interviews were held with 22 involved health care professionals (i.e. clinicians, nursing staff, dieticians, and nutritional assistants) from different health care settings, and three focus group interviews were held with 13 dieticians and nurses.

      Results

      At a professional level, some health care professionals experienced lack of knowledge about nutritional care. At a system level, health care professionals reported lack of structured attention for patients' nutritional status, and nurses reported limited time available. Continuity of nutritional care was perceived to be at risk due to: 1. Incomplete communication between institutions, 2. Lack of clarity in nutrition-related responsibilities, and 3. Diversity in nutritional care policy between institutions.

      Conclusions

      Barriers for implementation of the nutritional intervention are related to communication problems and differences in nutritional care policies between institutions. These barriers may be improved by clearly assigning nutrition-related responsibilities, by extensive cooperation between involved disciplines, and by monitoring patients until at home.
      The trial was registered at http://clincialtrials.gov/ as NCT00523575.

      Keywords

      Abbreviation:

      ONS (Oral nutritional supplements)
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