Marketing Nutrition to Physicians

State: CO Type: Model Practice Year: 2007

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Marketing Nutrition to Physicians targets Obstetric, Pediatric and Family Practice physicians in the Tri-County Health Department (TCHD) area serving Adams, Arapahoe and Douglas Counties. The practice addresses the issues of developing community collaborations, increasing breastfeeding rates, and decreasing childhood obesity. The practice has two main goals:

  • Goal 1: Improve physician awareness of nutrition and WIC (Special Supplemental Nutrition Program for Women, Infants and Children) services provided.
  • Goal 2: Provide an experiential public health research project to Dietetic interns.

A strong community partnership has formed between the TCHD Nutrition Division and area physicians. Physicians are using the health department as a resource and are requesting additional materials and referral information for their patients. Six-month follow-up survey results show that staff at eleven of the offices (53%) are accessing the resource information at least daily for patient education. The project has proven to be an effective public health research project for dietetic interns which meets American Dietetic Association (ADA) competencies C02 (Conduct community-based nutrition program outcome assessment/evaluation), C04 (Participate in nutrition surveillance and monitoring of communities) and C05 (Participate in community-based research) for accreditation of public health-emphasis dietetic practice programs.

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Tri-County Health Department
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Marketing Nutrition to Physicians
Marketing Nutrition to Physicians targets Obstetric, Pediatric and Family Practice physicians in the Tri-County Health Department (TCHD) area serving Adams, Arapahoe and Douglas Counties. The practice addresses the issues of developing community collaborations, increasing breastfeeding rates, and decreasing childhood obesity. The practice has two main goals: Goal 1: Improve physician awareness of nutrition and WIC (Special Supplemental Nutrition Program for Women, Infants and Children) services provided. Goal 2: Provide an experiential public health research project to Dietetic interns. A strong community partnership has formed between the TCHD Nutrition Division and area physicians. Physicians are using the health department as a resource and are requesting additional materials and referral information for their patients. Six-month follow-up survey results show that staff at eleven of the offices (53%) are accessing the resource information at least daily for patient education. The project has proven to be an effective public health research project for dietetic interns which meets American Dietetic Association (ADA) competencies C02 (Conduct community-based nutrition program outcome assessment/evaluation), C04 (Participate in nutrition surveillance and monitoring of communities) and C05 (Participate in community-based research) for accreditation of public health-emphasis dietetic practice programs.
Colorado children up to age five, have an overweight rate of 15%, increasing risk for chronic disease. The needs assessment survey revealed 50% of physician offices had a pediatric obesity rate over 15%, above the state average. According to PEDNESS (Pediatric Nutrition Surveillance), the 6-month breastfeeding duration rate was 30% for Adams County, 28% for Arapahoe County and 44% for Douglas County. Each county falls below the HP2010 goal of 50% of women breastfeeding at 6 months postpartum. Breastfeeding is associated with lower rates of obesity but physicians receive little training in this area. The needs assessment survey revealed none of the offices offered breastfeeding training for staff and 75% of physicians wanted breastfeeding resources for both patients and providers. Eighty eight to 100% of offices surveyed requested childhood obesity and breastfeeding pamphlets, referral lists for patients and providers and promotional items. The program implemented by TCHD was tailored to the needs of the target audience. The materials developed were designed to help decrease childhood obesity rates and improve breastfeeding duration rates by improving physician knowledge, providing up-to-date patient information in the requested formats, and introducing TCHD as a resource and community partner with nutrition experts in both of these fields. The regular and personal follow-up with physician offices will allow us to continue to evaluate materials and be responsive to the needs of our target population. TCHD has taken the lead role in initiating contact with physicians regarding WIC patient care in the past, but has not been viewed as a resource by physicians. The TCHD Nutrition Division viewed this as a missed opportunity to coordinate care and provide nutrition expertise in the areas of childhood obesity and breastfeeding. Data indicate that improvements need to be made in Colorado in the areas of childhood obesity prevention and increasing breastfeeding duration. In Colorado, there are few programs available for the prevention and treatment of childhood obesity and families turn to their physicians for support and advice. The needs assessment survey identified that over 70% of physicians address obesity during patient visits yet less than 30% collaborate with a registered dietitian for counseling. WIC dietitians can fill this role, however, only half of the practices surveyed were familiar with WIC services. A review of existing materials found very few breastfeeding tools that focus on general client education. Colorado has an active breastfeeding task force yet no programs currently exist to put tailored education materials in physician offices. While other physician resources exist, this project is unique by providing childhood obesity and breastfeeding materials tailored for physicians working with low-income WIC families with an emphasis on building a community partnership with these physicians to improve patient care. The materials can be easily tailored to meet the needs of each individual physician office and are updated with new information on a regular basis through personal visits from a TCHD registered dietitian. Another unique aspect of this project is conducting the needs assessment project with dietetic interns who fulfill a portion of their training competencies and provide the health department with an economical way of completing the needs assessment survey process.
Agency Community RolesThe TCHD Nutrition Division initiated this project and continues to coordinate all program activities. The successful collaboration formed between the TCHD Nutrition Division and physicians in Adams, Arapahoe and Douglas Counties was a main focus of the project. Physicians played a key role in project planning, implementation, and outcomes. Future collaboration and open communication with physicians will continue through personal visits by the WIC registered dietitians and physician initiated phone calls. We partnered internally with the Dietetic Internship Program Director to train dietetic interns to complete portions of the project. New dietetic interns will be trained and play a role in future community assessments and updating the resource materials. The Epidemiology Planning and Communication Division (EPC) assisted with project planning and evaluation. TCHD partnered with the Colorado Physical Activity and Nutrition Program through the Colorado Department of Public Health and Environment who awarded TCHD with a grant to develop the breastfeeding materials. Another community partner was Medela who provided the lunch at the physician office presentations. TCHD registered dietitians participate on numerous community coalitions and task forces which deal with the public health issues of decreasing childhood obesity and increasing breastfeeding duration rates. The breastfeeding materials were presented to professionals at a Colorado Breastfeeding Task Force meeting.  Costs and ExpendituresFunding sources included: TCHD WIC program, Colorado Physical Activity and Nutrition Program through the Colorado Department of Public Health and Environment, and a Medela education grant. Start-up costs were covered in part by grants from the Colorado Physical Activity and Nutrition Program and Medela. Unpaid dietetic interns completed the needs assessment. In-kind costs included project coordinator time to make contact with physician offices, set up lunch presentations, assemble materials, train staff and analyze data. Nutrition division staff time to gather and analyze data and visit the physician offices. ImplementationThis project has developed over the last three years. In phase one of the project, a committee of registered dietitians from the Nutrition Division at Tri-County Health Department (TCHD) created a plan to strengthen collaboration efforts with physicians in Adams, Arapahoe, and Douglas Counties to improve community health. The TCHD dietetic intern class received community needs assessment and survey implementation training as part of their internship curriculum, meeting ADA competencies C02, C04 and C05. The interns completed a survey with physicians in Adams, Arapahoe and Douglas counties who serve a large population of clients who participate in the TCHD Special Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) to elicit what nutrition materials they were currently using in their practice and what materials were needed for patient education. The two broad categories identified by physicians as a need for intervention were breastfeeding and childhood obesity. In phase 2 the following year, the project continued with another TCHD dietetic intern class completing the same training and conducting a follow-up survey with physicians who serve a large population of clients who participate in the TCHD WIC Program. The follow-up survey focused on refining the types of breastfeeding and childhood obesity materials desired and the form in which the physician offices would prefer to receive the information. The interns, supervised by Nutrition Division and the Epidemiology, Planning and Communication Division staff, analyzed data from the two surveys and presented their program recommendations to nutrition division staff. In phase 3 the following year, breastfeeding and child healthy weight materials were identified, based on survey responses. Materials were distributed to area physicians. Materials included pamphlets in English and Spanish, resource lists for patients and physicians, assessment tools, nutrition counseling tips, obesity and breastfeeding key message promotion ideas, information about the Special Supplemental Food and Nutrition Program for Women Infants and Children and the Tobacco Prevention Program. A lunch presentation was scheduled for staff at twenty-one physician offices. The presentation contained information on how using the materials could save provider time, improve patient care, and showcase services TCHD and the Nutrition Division offer. A WIC registered dietitian presented the materials at the physician offices where she would serve as the liaison between the health department and the physician offices.  
Objective 1: By December 31, 2005, a) survey a random sample of physician offices who serve WIC clients in Adams, Arapahoe, and Douglas Counties to deter-mine current practices in providing nutrition education, b) complete a follow-up survey with a random sample of physician offices serving WIC clients in Adams, Arapahoe and Douglas Count-ies to determine what educational materials and assessment tools could be provided by TCHD to assist physician offices in pre-venting childhood obesity and increasing breastfeeding duration rates.  Performance Measures: A minimum of eight initial physician office surveys were completed and a minimum of eight physician office follow-up surveys completed. Outcomes: Eight initial physician office surveys were completed and eight follow-up physician office surveys were completed. Objective 2: By June 30, 2006, provide nutrition and WIC resources on breastfeeding and childhood obesity to a minimum of five physicians and their office staff in each TCHD County. Performance Measures: Nutrition and WIC resources will be provided to 5 physician offices in Adams County, 5 physician offices in Arapahoe County and 5 physician offices in Douglas County. Outcomes: Twenty-one presentations were completed and exceeded expectations. Objective 3: By December 31, 2006, a) at least 50% of participating physician offices will access the resource materials at least one time per day, b) complete one-on-one follow-up a minimum of one time a year at each physician office that received materials to reinforce use of resource materials and nutrition services, replenish materials, provide additional materials as needed and maintain the established partnership between TCHD and physicians. Performance Measures: a)Half of the physician offices will access the resource materials at least one time a day. b)Follow-up visits will be completed a minimum of one time a year at each physician office that received resource materials.  Outcomes: a) 53% of physician offices had staff that accessed the resource materials at least one time a day for patient education. b) 100% of physician offices that received resource materials received a follow-up visit from a WIC registered dietitian.
SustainabilityThe comprehensive needs assessment completed at the beginning of this project helped assure physician buy-in and will aid in sustainability. A successful collaborative relationship has been established between TCHD WIC registered dietitians and area physicians. Physicians have contacted TCHD to request additional copies of pamphlets and other materials such as posters to support healthy weight and breastfeeding messages in their offices. Physicians are also using TCHD as a community resource to find referral information for low-income patients such as information about Medicaid and food assistance programs. This partnership will remain and continue to improve with each contact between TCHD registered dietitians and physician office staffs. A registered dietitian is designated as the program coordinator to assure that project guidelines are followed. TCHD administration supports the project and will help secure funding to provide additional materials to the physician offices as they are requested. By coordinating client care between physicians and the WIC program through collaboration, unified messages and care centered on the importance of a healthy childhood weight and breastfeeding, the health of the community as a whole will improve. Lessons LearnedLessons learned and modifications to the practice include: Lesson learned: Face to face contacts with physicians and their staff are beneficial in improving nutrition care of patients. Modifications made: Need to continue personal contact with physician offices on a regular basis. Expansion of services to more physician offices needs to be evaluated yearly. Lesson learned: Physicians have busy schedules and it was difficult to make the initial presentation schedule before the collaborative relationship was established. Modifications made: Follow-up visits are done with one physician office staff member who serves as that office contact person and shares information with the entire staff. Meetings with the contact person are easier to schedule than trying to talk with all of the staff at one time. Lesson learned: There was no common theme around what resource materials were and were not being used. A majority of offices were using all of the resource materials. Two of the office were not using a few of the pamphlets. Modifications made: No changes were made to the resource materials from survey results. Lesson learned: Physicians have busy schedules and it was difficult to make the initial presentation schedule before the collaborative relationship was established. Modifications made: Follow-up visits are done with one physician office staff member who serves as that office contact person and shares information with the entire staff. Meetings with the contact person are easier to schedule than trying to talk with all of the staff at one time.
 
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