SMART GOAL SETTING IN CURRENT DIETETIC PRACTICE IN PRIMARY CARE IN THE NETHERLANDS:

RATIONALE: Current developments drive dieticians in the primary care setting to demonstrate their effectiveness to both patients and stakeholders. Working with SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goal setting may increase effectiveness. This study describes the current dietetic practice in the primary care setting in The Netherlands with regard to goal setting.

METHODS:

This observational study was part of the DIEET study (DIEtetics: Effective and Towards a sustainable profession).Trained students performed structured observations during first dietetic consultations of patients with overweight (BMI 25 kg/m2) (38%), diabetes mellitus type 2 (35%), hypercholesterolemia (15%), hypertension (2%), or malnutrition (9%) in the primary care setting. Amongst numerous other factors, observations focused on (SMART) goal setting and nutritional assessment (NA). Chi-square tests were used to express associations between treatment goals and NA.

RESULTS:

54 observations were performed in 17 male (32%) and 37 female patients (56.1±16.0 y) visiting 54 dieticians (44.5±10.8 y). In 40 (74%) consultations treatment goals were defined [specific (n = 38), measurable (n = 28), attainable (n = 31), realistic (n = 23), time-bound (n = 13)], of which 12 (22%) were SMART. In 40 (74%) consultations NA was performed, including measurements of weight (74%), height (20%), BIA (32%) and waist circumference (11%). Goal setting in general was related to performing NA (83%, p = 0.02), but SMART goal setting was only related to performing BIA measurement (41%, p = 0.02).

CONCLUSIONS:

These preliminary results indicate that, incurrent practice, primary care dieticians define treatment goals in 74% of first consultations, but only 22% of dieticians set SMART goals. The DIEET study will further explore whether SMART goal setting during the first consultation will result in higher effectiveness.