Nutritional counselling in general practice: a cost effective analysis

Study objective-To study the clinical and cost outcomes of providing nutrit ional counselling to patients with one or more of the following conditions: overweight, hypertension and type 2 diabetes. Design-The study was designed as a random controlled trial. Consecutive pat ients were screened opportunistically for one or more of the above conditio ns and randomly allocated to one of two intervention groups (doctor/dietiti an or dietitian) or a control group. Both intervention groups received six counselling sessions over 12 months from a dietitian. However, in the docto r/dietitian group it was the doctor and not the dietitian who invited the p atient to join the study and the same doctor also reviewed progress at two of the six counselling sessions. Setting-The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth, Western Australia. Patients-Of the 273 patients randomly allocated to a study group, 198 were women. Age ranged from 25 to 65 years. Seventy eight per cent of patients r esided in the lower two socioeconomic quartiles, 56 per cent described thei r occupation as home duties and 78 per cent were partnered. Results-Both intervention groups reduced weight and blood pressure compared with the control group. Patients in the doctor/dietitian group were more L ikely to complete the 12 month programme than those in the dietitian group. Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $A9.76 per kilogram, while the dietitian group lost 5.6 kg at a cost of $A7.30 per kilogram. Conclusion-General practitioners, in conjunction with a dietitian, can prod uce significant weight and blood pressure improvement by health promotion m ethods.