Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Interventions and public health nutrition

What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France

Abstract

BACKGROUND/OBJECTIVES:

Malnutrition is associated with a high morbi-mortality in elderly populations and their institutionalization at an early stage. The incidence is well known despite being often under-diagnosed in primary care. General practitioners (GPs) have a key role in home care. What are the factors affecting malnutrition-screening implementation by French GPs?

SUBJECTS/METHODS:

We conducted a cross-sectional survey in two areas in the southeast of France (Savoie and Isère). In May 2008, an anonymized survey was sent by e-mail and/or post to all GPs with a large clinical practice. Two months later, reminder letters were sent. Potential barriers were measured by dichotomous scale. On GPs’ characteristics (socio-demographic, medical training, geriatric practice and knowledge), multiple regression logistic was performed to identify others factors affecting malnutrition screening.

RESULTS:

In all, 493 GPs (26.85%) answered and 72.2% felt that malnutrition screening was useful although only 26.6% implemented it each year and 11.9% every 2–5 years. The main barriers to the implementation were patient selection (60.4%) and forgetting to screen (26.6%). Minor barriers were lack of knowledge (19.5%) or time (15%). New factors were identified: unsuitable working conditions (19.1%), insufficient motivation (6.8%) or technical support (7.2%). The quality of malnutrition information received was found to be the only promoter of annual screening (odds ratio=1.44 (1.087–1.919); P=0.011).

CONCLUSIONS:

This survey is the first in France to reveal GPs’ factors affecting malnutrition implementation. New obstacles were identified in this survey. The hope of implementing regular malnutrition screening by GPs seems to lie with the quality of malnutrition information received.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. National Institute of Statistics and Economic Studies. Demographic balance in 2008. INSEE Première [Internet] 2009, Jan (modified on 06/2009) 1220: 1–4. [Consulted on 13/09/2012]. Available at http://www.insee.fr/fr/ffc/ipweb/ip1220/ip1220.pdf French.

    Google Scholar 

  2. General Medical Council. Medical demography in 2011 2011, [Consulted on 13/09/2012]. Available at http://www.conseil-national.medecin.fr/system/files/Atlas2011.pdf?download=1 French.

  3. High Council of Public Health. Health in France in 2002. La documentation française 2002, 412p [Consulted on 13/09/2012]. Available at http://www.hcsp.fr/hcspi/docspdf/hcsp/hc001174.pdf French.

  4. Labarthe G . Consultations and visits of General Practitioners, a typology essay. Études et Résultats. DREES 2004; 315: 1–12. French.

    Google Scholar 

  5. French National Authority for Health (HAS). Malnutrition in the elderly – Nutritional support strategy – Guidelines 2007, avr; 1-22 [Consulted on 13/09/2012]. Available at http://www.has-sante.fr/portail/upload/docs/application/pdf/malnutrition_elderly_guidelines.pdf French.

  6. Covinski KE, Martin GE, Beyth RS, Justice AC, Sehgal AR, Landefeld CS . The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. J Am Geriatr Soc 1999; 47: 532–538.

    Article  Google Scholar 

  7. Feldblum I, German L, Castel H, Harman-Bohen I, Bilenko N, Eisinger M et al. Characteristics of undernourrished older medical patients and identification of predictors for undernutrition status. Nut J 2007; 6: 37–45.

    Article  Google Scholar 

  8. Visvanathan R, Macintosh C, Callary M, Penhall R, Horowitz M, Chapman I . The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months. J Am Geriatr Soc 2003; 51: 1007–1011.

    Article  Google Scholar 

  9. Glantz K . Review of nutrition attitudes and counselling of primary care physicians. Am J Clin Nutr 1997; 65 (Suppl), S2016–S2019.

    Article  Google Scholar 

  10. Raynaud-Simon A, Lesourd B . Dénutrition du sujet âgé: conséquences cliniques (Malnutrition in older patients: clinical consequences). Press Med 2000; 2183–2190. French.

  11. Wenger NS, Solomon DH, Roth CP, MacLean CH, Salba D, Kamsberg CJ et al. The quality of medical care provided to vulnerable community-dwelling older patients. Ann Intern Med 2003; 139: 740–747.

    Article  Google Scholar 

  12. Elia M, Zellipour L, Stratton RJ . To screen or not to screen for adult malnutrition. J Am Clin Nutr 2005; 24: 2867–2884.

    Google Scholar 

  13. Gayrard P, Harzo C, Clerget M-P . Enquête auprès des Conseils Généraux, des CLICs, des Réseaux et des médecins généralistes de la région Rhône-Alpes [Internet]. URML RA Edition: France, 2005; 1–108. [Consulted on 13/09/2012]. Available at http://www.urmlra.org/upload/urmlra/urm_etude/pj/GERONTOLOGIE.pdf French.

    Google Scholar 

  14. Observatoire Régional de la Santé Provence-Alpes-Côtes d'Azur, INSERM U379. Pratiques des médecins généralistes en matière de prévention et opinions sur les réformes du système de santé: les enseignements du panel de médecins généralistes de la région Provence-Alpes-Côtes d'Azur 2006; 16: 1–6. [Consulted on 13/09/2012]. Available at http://www.sesstim-orspaca.org/syntheses_resultats/pdf/06-SY14.pdf French.

  15. Pouchain D, Huas D, Druais PL, Wolf B . Implication des médecins généralistes dans la prévention. Rev Prat Med G 1998; 12: 31–37. French.

    Google Scholar 

  16. Beaulieu MD, Huden E, Roberge D, Pineault R, Forte D, Legere J . Practice guidelines for clinical prevention: do patients, physicians and experts share common ground? CMAJ 1999; 161 (5), 519–523.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Pelletier-Fleury N, Le Vaillant M, Hebbrecht G, Boisnault P . Determinants of preventive services in general practice. A multilevel approach in the cardiovascular domain and vaccination in France. Health Policy 2007; 81: 218–227.

    Article  Google Scholar 

  18. Pelletier-Fleury N, Le Vaillant M, Szidon P, Marie P, Raineri F, Sicotte C . Preventive service delivery: a new insight into French general practice. Health Policy 2007; 83: 268–276.

    Article  Google Scholar 

  19. Brotons C, Bjorkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E et al. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40: 595–601.

    Article  Google Scholar 

  20. McAvoy BR . A scandal of inaction: how to help GPs implement evidence-based health promotion. Br J Gen Pract 2000; 50: 180–181.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. McWhirther J, Pennington C . Incidence and recognition of malnutrition in hospital. Br Med J 1994; 308: 945–948.

    Article  Google Scholar 

  22. Wiesemann A . Nutritional counseling in German general practices: a holistic approach. Am J Clin Nutr 1997; 65 (Suppl), S1957–S1962.

    Article  Google Scholar 

  23. Meijers JM, Halfens RJ, Van Bokhorst DE, Van Der Schueren MA, Dassen T, Schols JM . Malnutrition in Dutch health care: prevalence, prevention, treatment, and quality indicators. Nutrition 2009; 25: 512–519.

    Article  Google Scholar 

  24. Helman A . Nutrition and general practice: an Australian perspective. Am J Clin Nutr 1997; 65 (Suppl), S1939–S1942.

    Article  Google Scholar 

  25. Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M . Nutritional routines and attitudes among doctors and nurses in Scandinavia: a questionnaire based survey. Clin Nutr 2006; 25: 1040–1048.

    Article  Google Scholar 

  26. Eaton CB, Goodwin MA, Stange KC . Direct observation of nutrition counselling in community family practice. Am J Prev Med 2002; 23: 174–179.

    Article  Google Scholar 

  27. Kushner RF . Barriers to providing nutrition counselling by physicians: a survey of primary care practitioners. Prev Med 1995; 24: 546–552.

    Article  CAS  Google Scholar 

  28. Bratland SZ . Handling nutritional advice in general practice in Norway. Am J Clin Nutr 1997; 65 (Suppl), S1953–S1956.

    Article  Google Scholar 

  29. Truswell AS, Hiddink G, Blom J . Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities. Am J Clin Nutr 2003; 77 (Suppl), S1089–S1092.

    Article  Google Scholar 

  30. Verheijden MW, Bakx JC, Van Weel C, Van Staveren WA . Potentials and pitfalls for nutrition counselling in general practice. Eur J Clin Nutr 2005; 59 (Suppl), S122–S129.

    Article  Google Scholar 

  31. Temple NJ . Survey of nutrition knowledge of Canadian physicians. Am J Clin Nutr 1999; 18: 26–29.

    CAS  Google Scholar 

  32. Hiddink GJ, Haustvast JG, Van Woerkum CM, Fieren CJ, Van't Hof MA . Nutrition guidance by primary care physicians: perceived barriers and low involvement. Eur J Clin Nutr 1995; 49 (11), 842–851.

    CAS  PubMed  Google Scholar 

  33. Butriss JL . Food and nutrition attitudes, beliefs and knowledge in the United Kingdom. Am J Clin Nutr 1997; 65 (Suppl), S1985–S1995.

    Article  Google Scholar 

  34. French General Medical Council. Medical demography atlas in Rhône-Alpes, France. Situation on January 1st 2009. [Consulted on 13/09/2012]. Available at http://www.conseilnational.medecin.fr/sites/default/files/RhoneAlpes.pdf French.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Y Gaboreau.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gaboreau, Y., Imbert, P., Jacquet, JP. et al. What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France. Eur J Clin Nutr 67, 1193–1199 (2013). https://doi.org/10.1038/ejcn.2013.161

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.161

Keywords

This article is cited by

Search

Quick links