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Integrating Components of the Patient-Centered Medical Neighborhood into Nutrition Counseling for Hypertension within a Grocery Store: an Instrumental Case Study

Watowicz, Rosanna P
http://rave.ohiolink.edu/etdc/view?acc_num=osu1469053300

Abstract Details

2016, Doctor of Philosophy, Ohio State University, Health and Rehabilitation Sciences.
Over the past decade, the patient-centered medical home has emerged as a model for the delivery of healthcare. Patient-centered medical homes are expected to provide comprehensive care for their patients, however some services may not be available within the physical medical home. The patient-centered medical neighborhood model fills this gap; primary care providers refer their patients to healthcare services elsewhere in the community and then the community-based practitioners communicate with the primary care provider to coordinate care for the patient. Registered dietitians are effective at promoting behavior change and often are available in community setting, particularly in grocery stores. They also can offer flexible scheduling and hands-on education. However, since the dietitians are not connected to the patient’s electronic medical record, communication back to the primary care physician is challenging. This instrumental case study examined nutrition counseling for 30 adults with hypertension, provided by a grocery store-based dietitian, and the communication back to the primary care provider using a novel, web-based nutrition charting portal. Changes in participants’ systolic blood pressure and dietary intake were assessed following the 12-week nutrition intervention. Patients, primary care providers, and dietitians also were interviewed in order to qualitatively assess the feasibility and acceptability of the patient-centered medical neighborhood model among the three groups of stakeholders. Of the 30 adults enrolled, 19 completed the study protocol. Systolic blood pressure decreased, on average, by 3.6 mm Hg (SD 16.2 mm Hg; 95% CI -4.2 to 11.4 mm Hg) though this change was not statistically significant. Diet quality, as measured by the Healthy Eating Index 2010 total score, improved significantly with a mean increase of 11.6 (95% CI 7.7 to 15.5; P <0.001). Patients reported high satisfaction with the grocery store-based intervention and did not report any drawbacks to being seen in a grocery store compared to a more traditional healthcare setting. In interviews, several participants reported a preference for the grocery store compared to a medical office. Eighty four percent of the nutrition visit summaries generated by the web-based charting portal were successfully scanned into the patients’ electronic medical records, and while primary care providers felt that these summaries were helpful, there also were technical barriers to accessing the summary reports during a patient’s follow-up visit. The registered dietitians expressed a desire for bi-directional communication with the primary care providers. Overall, the intervention showed feasibility and acceptability, and also was related to important dietary changes. Additional research is needed to optimize care coordination between primary care providers and practitioners located in the medical neighborhood.
Christopher Taylor, PhD, RD, LD (Committee Member)
Sarah Anderson, PhD (Committee Member)
Amy Darragh, PhD, OTR/L (Committee Member)
Randell Wexler, MD, MPH, FAAFP (Committee Member)
133 p.
Nutrition
patient-centered medical neighborhood; nutrition counseling; hypertension

Recommended Citations

Citations

  • Watowicz, R. P. (2016). Integrating Components of the Patient-Centered Medical Neighborhood into Nutrition Counseling for Hypertension within a Grocery Store: an Instrumental Case Study [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1469053300

    APA Style (7th edition)

  • Watowicz, Rosanna. Integrating Components of the Patient-Centered Medical Neighborhood into Nutrition Counseling for Hypertension within a Grocery Store: an Instrumental Case Study. 2016. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1469053300.

    MLA Style (8th edition)

  • Watowicz, Rosanna. "Integrating Components of the Patient-Centered Medical Neighborhood into Nutrition Counseling for Hypertension within a Grocery Store: an Instrumental Case Study." Doctoral dissertation, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1469053300

    Chicago Manual of Style (17th edition)

osu1469053300
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© 2016, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.