Barriers and facilitators of nutritional intervention after hip fracture in integrated care as perceived by the different health care professionals: A qualitative interview study

Abstract

summary Background & aims: Nutritional intervention in elderly hip fracture patients is important, but implementation is difficult. In order to identify barriers and facilitators for implementation, we conducted a qualitative interview study within the setting of a multicentre RCT, and evaluated the experiences of health care professionals with an applied intensive nutritional intervention comprised of dietetic counselling and oral nutritional supplements. Methods: Individual semi-structured interviews were held with 22 involved health care professionals (i.e. clinicians, nursing staff, dieticians, and nutritional assistants) from different health care settings, and three focus group interviews were held with 13 dieticians and nurses. Results: At a professional level, some health care professionals experienced lack of knowledge about nutritional care. At a system level, health care professionals reported lack of structured attention for patients’ nutritional status, and nurses reported limited time available. Continuity of nutritional care was perceived to be at risk due to: 1. Incomplete communication between institutions, 2. Lack of clarity in nutrition-related responsibilities, and 3. Diversity in nutritional care policy between institutions. Conclusions: Barriers for implementation of the nutritional intervention are related to communication problems and differences in nutritional care policies between institutions. These barriers may be improved by clearly assigning nutrition-related responsibilities, by extensive cooperation between involved disciplines, and by monitoring patients until at home. The trial was registered at http://clincialtrials.gov/ as NCT00523575.