Everyone knows that family physicians provide comprehensive health care to new moms and their babies, but those well-baby visits present a challenge because there is so much to cover in a 15-minute appointment.
And so too often, discussions about nutrition for both mother and infant miss out on the attention they deserve.
New research titled "Exploring Family Medicine Providers' Perspectives on Group Care Visits for Maternal and Infant Nutrition Education,"(www.jneb.org) published in the April issue of the Journal of Nutrition Education and Behavior, looks at group visits as a way to provide this vital information to women.
Corresponding author Alexandra MacMillan Uribe, Ph.D., R.D., a postdoctoral associate in the Department of Nutritional Sciences at the University of Wisconsin-Madison, conducted face-to-face interviews with 18 family physicians from April through July 2016 and utilized 17 of those transcripts for this study.
- New research shows that family physicians support utilizing group visits to provide postpartum mothers with nutrition education for themselves and their baby.
- Physicians interviewed for the study said time constraints and lack of nutrition education inhibited their ability to provide this information to patients.
- Family physicians discussed the benefits and barriers to implementing maternal group visits in their clinics.
Physician interviews were guided by three basic research questions:
- What are family physicians currently doing to educate new mothers about maternal nutrition and infant feeding?
- If nutrition education were provided to mother-infant dyads, how could it best be delivered in a family medicine clinic?
- How do family physicians perceive using a group care model to deliver nutritional education to this group of patients?
MacMillan Uribe told AAFP News it is an important topic for family physicians to consider.
"Group care is an opportunity for family physicians to provide comprehensive education on preventive topics for both mothers and infants, including nutrition, which is often intertwined during the first year postpartum," she said.
"We see from previous research that taking an active role in one's own care is associated with better health outcomes, and mothers with infants are able to do that through the group-care model. From the interviews, I found that physicians didn't have enough time to discuss topics in-depth, so this would provide an opportunity to do so."
Authors noted in their introduction that in most primary care clinics, new mothers typically are allotted just one visit to cover postpartum care, and even though well-baby visits occur frequently during that first year of life -- some seven visits -- physicians devote an average of 42 seconds to infant feeding at those visits.
Group visits are much longer -- 90 to 120 minutes -- and therefore provide ample opportunity for nutrition education. Researchers viewed family medicine clinics as the optimal venue to explore this option because both mom and baby likely are patients.
"Nutrition education helps mothers make better dietary choices and teaches desirable infant feeding practices, ameliorating maternal and infant obesity risk," said the authors.
Nearly all family physicians interviewed said they provided very little maternal nutrition education during the postpartum visit due to time constraints.
One family physician said, "There's always a time limitation in any visit. In an infant well-baby visit, you're talking about development. Feeding is a huge part … but you're also talking about postpartum depression, adjusting to having a baby, safe sleep -- there's a lot of competing stuff."
Several FPs also noted their lack of training on nutrition counseling. "The nutritional education we get as med students and residents is pretty poor," said one participant.
In short, wrote the authors, "Insufficient time, too many topics to cover and lack of training led to a reactive approach." All participants agreed that nutrition education might be better delivered via group visits, home health visits, or add-on visits with a dietician or lactation consultant.
Among those choices, group care visits were favored by most participants as the best option and a model many FPs already had experience with among other patient groups.
Physicians cited peer-to-peer social support as an advantage to group visits and many expected that new mothers would enjoy learning from one another and sharing similar experiences.
Other benefits of a group visit that physicians noted include the ability to
- utilize expertise from dieticians and lactation consultants,
- improve the effectiveness of primary care visits,
- instill a cost-effective approach to delivering primary care,
- enhance access to services,
- increase patient engagement,
- facilitate challenging conversations, and
- attract additional patients to the clinic.
Family physicians also pointed out possible barriers to implementing the model in their clinics. For instance, they discussed
- recruitment and retention of patients;
- logistics of starting and sustaining a group visit program;
- using curricula that would be inclusive of all patient groups, such as those with language barriers and those with nontraditional families; and
- addressing patient challenges, such as transportation, child care and extended appointments.
Some physicians worried that group visits might negatively affect the physician-patient relationship by separating mothers from their physician.
One family physician from a small rural clinic said just gathering enough new moms together to create a group would be an issue. "I think group classes would be great, but the problem is, we don't have enough volume at one time," he said.
Physicians also proposed solutions to possible barriers. For instance, they said clinics could
- provide incentives for women to pique their interest in the concept,
- allow time for private discussions with the primary care physician in addition to group visits for patients worried about sharing in a group setting,
- perform a community-needs assessment and secure buy-in from the administration or insurance payers before implementation,
- collaborate with neighboring clinics to ensure adequate volume, and
- alternate group visits with one-on-one visits to maintain the physician-patient relationship.
In addition, physicians suggested patients should self-select to participate in group visits and have the option to return to regular visits.
"Implementing a group care program that addresses the issues raised by participants -- and evaluating the effectiveness of group care in providing nutrition education to mothers with infants -- are important next steps," wrote the authors.
Additional Author Comment
Researcher MacMillan Uribe provided the following additional insights.
Q. Did the physician interviews result in any unexpected findings?
A. I was surprised by how often group care came up before physicians were even prompted to discuss this approach. I think it reflects how popular this model is becoming within primary care. Another thing that struck me was that physicians were very open to having other professionals/experts provide nutrition education.
Q. What did you find most compelling about these physician interviews?
A. Despite the challenges of instituting a group-care model -- especially the logistics and planning involved -- physicians were still enthusiastic about this approach. They were quite excited when I presented the model in the last segment of the interviews, and they were open to trying a new approach to educating their patients on preventive topics.
Q. What's a key takeaway for family physicians?
A. Given the excitement for the group-care model, if physicians are interested in instituting group care in their own practices, they may be met with a lot of support and enthusiasm from other physicians. It's important for physicians to consider the challenges and solutions that surfaced during the interviews.
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