Number of consultations, treatment time and effectiveness of dietetic treatment in primary care in the Netherlands: results of the DIEET-project

This article describes the number and types of consultations, treatment time and effectiveness of dietetic treatments in primary care in the Netherlands.

The DIEET (DIEtetics Effective and Towards a sustainable profession) project is a nationwide prospective observational study. Characteristics of clients treated for overweight, Diabetes Mellitus type 2 (DM2), hypercholesterolemia, malnutrition or hypertension were recorded at baseline, and the number and kind of consultations and treatment time was recorded at 9 months. Effectiveness was determined by predefined criteria for weight change, BMI, and/or medication use. Differences in the median number of consultations and treatment time between men/women, clients with a Dutch background or a migration background and with or without referral was tested with a Mann-Whitney U test, between SES groups and primary diagnoses with a Kruskall-Wallis test with post hoc Dunn’s pairwise comparison with Bonferroni correction, and between effective and non-effective treated clients with a Mann-Whitney U test Multivariable logistic regression analysis was done with effectiveness as outcome and number of consultations and treatment time as explanatory factor, corrected for the characteristics of the client (two-sided alpha=0.05).

605 clients met the inclusion criteria, data was available for 393 clients. Mean age was 55,5 ± 14,5 years, 59% was women. Primary diagnoses were overweight (48%), DM2 (35%), hypercholesterolemia (9%), malnutrition (6%), and hypertension (2%). For 41% treatment was still ongoing after 9 months. The median number of consultations was 5 (IQR:3-6), median treatment time was 180 min (IQR:135-225), of which 81% was direct time. The treatment time of 39% of the clients was longer than the reimbursed 180 minutes. Overweight clients received more consultations than clients with DM2 (5 (3-7) versus 4 (3-6); p= 0.02), or hypercholesterolemia (4 (3-5) borderline significant, p=0.10). Differences in treatment time between SES groups were borderline significant; high SES 170 min (IQR 105-210) versus low/middle SES 180 min (IQR middle SES 135-230, IQR low SES 105-210), p=0.08). 47% of the treatments was effective. Clients with an effective treatment received one consultation and 15 minutes more treatment than clients without an effective treatment (p=0.02 en p=0.05).

The median number of consultations was 5 (IQR:3-6), median treatment time was 180 min (IQR:135-225), Clients with an effective treatment within 9 months of dietetic treatment had a median of one consultation and a median consultation time of 15 minutes longer compared to clients with a non-effective treatment. Whether an extra consultation and extra time will increase the effectiveness of a dietary treatment has to be investigated.

Key words: dietetics, effectiveness, primary care