Practice and perspectives of Australian dietitians in management of patients on pancreatic enzyme replacement therapy

摘要

Prescribing pathways for Australian dietitians are limited in comparison to dietitians practising in New Zealand and the United Kingdom. Therefore where medication dose may be titrated relative to dietary intake, such as in pancreatic exocrine insufficiency, dietitians in Australia are unable to initiate therapy or adjust dosage.Aim: To explore current practice roles of Australian dietitians working with patients requiring pancreatic enzyme replacement therapy (PERT), and opinions and influences on these practices.Methods: An online survey and telephone interviews with self-nominated dietitians who identified with extended scope of practice with patients on PERT. Thematic analysis was undertaken through an inductive approach to better understand the contexts and reasoning around a dietitian's extended scope of practice.Results: The majority of participants in the online survey (74/81) described roles beyond traditional scope of practice with patients requiring PERT, especially in a multidisciplinary team environment. Most respondents (97%) believed PERT prescribing for dietitians would be beneficial. Nine semi-structured telephone interviews with experienced dietitians revealed perceived benefits of current advanced and informal extended scope of practice for dietitians including greater efficiency; improved patient care; increased job satisfaction and enhanced inter-professional communication. Dietitians believe they are adequately equipped to prescribe medication where dose is largely dependent upon diet.Conclusions: In Australia, it is common for dietitians in care of patients prescribed PERT to engage in informal, extended scope of practice. Further research is required to determine the framework to achieve formal extended scope of practice related to PERT and potentially other medications.