Physicians' Knowledge of Clinical Nutrition Discipline in Riyadh Saudi Arabia

Registered Dietitians' enteral feeding practices, obstacles, and needs during the management of critically Ill hospitalized patients in Riyadh, Saudi Arabia: A qualitative study

Objectives

Nutritional protocols and guidelines are essential to guide health-care practitioners toward effective enteral feeding management for critically ill patients. Despite the wide availability of international guidelines to direct enteral feeding practices, there are no nutritional guidelines regarding enteral feeding practices tailored for the Saudi Arabian population. In addition, different enteral feeding practices may result in negative outcomes like malnutrition.

Methods

A qualitative study was conducted through multiple focus group sessions. Pre-formulated structured open-ended questions were asked from the participants during the focus group sessions to gain an in-depth understanding of the current enteral feeding practices. All sessions were audio-recorded, and the transcript was coded and cross-validated.

Results

A total of five focus group sessions were conducted until data saturation was reached. Data saturation was reached when no additional information was mentioned in the fifth focus group session when compared to all previous sessions. All 24 participants were specialized in the clinical nutrition field with enteral feeding experience in critically ill patients and working in Riyadh city. Twelve themes of the current practices, four themes of obstacles, and four themes of needs were identified with subthemes.

Conclusion

This qualitative study shows different enteral feeding practices, obstacles, and needs among registered dietitians. Thus, the need for developing national nutritional guidelines tailored to local population characteristics is highlighted. National guidelines are recommended to be compatible with a defined registered dietitian role with clear standards of practices and responsibility for each discipline to achieve a competent health care service.

Comparison of nutrition care services for adult obesity at primary care in two different periods in Saudi Arabia

BACKGROUND

Dietitians are healthcare professionals with potential roles and impacts in primary care (PC) settings when applying knowledge and expertise to educate healthcare clients at all levels and treat chronic diseases. This study seeks to compare and evaluate the nutrition care services and practices in obesity management in primary care centres for two periods (2016 and 2019) in Jeddah city, Saudi Arabia.

METHODS

Surveys with service self-reporting evaluation used responses from 18 and 27 centres in 2016 and 2019. Services evaluation used no reference to a standard, but 18 of the surveyed PC centres in 2019 were previously visited in 2016 to assess the provided nutrition care services for adult obesity in PC centres. The re-visit survey investigated improvements in services achieved in 2019 concerning services for adults with obesity. A chi-square test was used to compare the surveys' results in the two periods, which resulted in a significant difference in the provided nutrition care services for adult obesity between 2016 and 2019.

RESULTS

Dietitians' employment has significantly changed (P < .0001) in 2019 compared to 2016. Dietitians were significantly noticed as the primary source of nutrition information after their integration into the services (P < .0001) in 2019. Services provided for adult obesity increased significantly (P value < .0001) in the second phase. However, there was no significant difference in serving adult groups between the two periods (P = .056).

CONCLUSIONS

Integrating dietitians into the PC services significantly enhanced their role in supporting PC services for conditions relating to adult obesity, which allowed them to be the most important source of the delivered nutrition information to patients. The employment rate of PC dietitians accredited by the governing body is significantly increasing; the Saudi Commission for Health Specialties will need to monitor it to ensure that dietitians have the qualifications and skills to provide professional medical nutrition therapy to patients. Further research to evaluate the quality of PC dietetic practice and improvements in patient outcomes is required to strengthen the importance of integrating registered dietitians into the services.

Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners

Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.