Key process and organization indicators in the dietetic management of dyslipidemia in Canada

Diet interventions for dyslipidemia can produce clinically relevant changes in lipoprotein levels. To determine whether current nutrition counselling practices are consistent with such interventions, we studied aspects of Canadian dietitians' practice. Respondents to a self-administered mail survey (n=350) described practice for three groups of clients: those without and those with cardiovascular disease counselled through ambulatory care, and those with cardiovascular disease who were hospitalized. The process-of-care factors assessed were time spent in initial and follow-up sessions, diet, anthropometry, blood lipids, physical activity, and social and genetic factors. Organization factors assessed included availability of medical history and laboratory data, and perceived support for counselling services. Initial individual interview times averaged one hour, with 49% to 57% of respondents offering scheduled follow-up services versus passive or no follow-up services. Overall, counselling practices were consistent with efficacious interventions, but there was wide variation. This was particularly evident in ambulatory care, where higher percentages of clients received follow-up care when respondents reported multidisciplinary group practice; better access to the medical history, and more frequent assessment of measured body weight, client social support, and laboratory data during follow-up care (all p < 0.01). Health care effectiveness may be improved through changes in the process and organization of services.