The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial
Abstract Purpose To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth. Methods The study was a 12-month pragmatic cluster random...
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2025-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13096-8 |
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| author | Tracy L. Schumacher Anna Jansson Jaimee Herbert Erin D. Clarke Carissa Alderton Penny Milson Christopher Oldmeadow Leanne J. Brown Megan E. Rollo Annabelle Williams M. Com Nutr Michelle Guppy Andrew Boyle Shanthi Ramanathan Jennifer May John Attia Clare E. Collins |
| author_facet | Tracy L. Schumacher Anna Jansson Jaimee Herbert Erin D. Clarke Carissa Alderton Penny Milson Christopher Oldmeadow Leanne J. Brown Megan E. Rollo Annabelle Williams M. Com Nutr Michelle Guppy Andrew Boyle Shanthi Ramanathan Jennifer May John Attia Clare E. Collins |
| author_sort | Tracy L. Schumacher |
| collection | DOAJ |
| description | Abstract Purpose To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth. Methods The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient’s general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability. Findings Sixteen PCPs recruited 132 eligible participants (n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months. Conclusions Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months. |
| format | Article |
| id | doaj-art-6f2b5e6bc7c8492ebff38179b2d22cd1 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-6f2b5e6bc7c8492ebff38179b2d22cd12025-08-20T03:45:56ZengBMCBMC Health Services Research1472-69632025-07-0125111610.1186/s12913-025-13096-8The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trialTracy L. Schumacher0Anna Jansson1Jaimee Herbert2Erin D. Clarke3Carissa Alderton4Penny Milson5Christopher Oldmeadow6Leanne J. Brown7Megan E. Rollo8Annabelle Williams9M. Com Nutr10Michelle Guppy11Andrew Boyle12Shanthi Ramanathan13Jennifer May14John Attia15Clare E. Collins16Department of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleFood and Nutrition Research Program, Hunter Medical Research InstituteDepartment of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleFood and Nutrition Research Program, Hunter Medical Research InstituteDepartment of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleDepartment of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleData Sciences, Hunter Medical Research InstituteDepartment of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleSchool of Population Health, Faculty of Health Sciences, Curtin UniversityHunter New England Central Coast Primary Health NetworkHunter New England Central Coast Primary Health NetworkSchool of Rural Medicine, University of New EnglandSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, University of NewcastleSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, University of NewcastleDepartment of Rural Health, College of Health Medicine and Wellbeing, University of NewcastleSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, University of NewcastleFood and Nutrition Research Program, Hunter Medical Research InstituteAbstract Purpose To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth. Methods The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient’s general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability. Findings Sixteen PCPs recruited 132 eligible participants (n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months. Conclusions Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months.https://doi.org/10.1186/s12913-025-13096-8Cardiovascular diseaseRural healthPrimary health careMedical nutrition therapyTelehealthDietitian |
| spellingShingle | Tracy L. Schumacher Anna Jansson Jaimee Herbert Erin D. Clarke Carissa Alderton Penny Milson Christopher Oldmeadow Leanne J. Brown Megan E. Rollo Annabelle Williams M. Com Nutr Michelle Guppy Andrew Boyle Shanthi Ramanathan Jennifer May John Attia Clare E. Collins The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial BMC Health Services Research Cardiovascular disease Rural health Primary health care Medical nutrition therapy Telehealth Dietitian |
| title | The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial |
| title_full | The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial |
| title_fullStr | The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial |
| title_full_unstemmed | The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial |
| title_short | The effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an Australian rural primary care setting: 12-month results from a pragmatic cluster randomised controlled trial |
| title_sort | effectiveness of medical nutrition therapy for people at moderate to high risk of cardiovascular disease in an australian rural primary care setting 12 month results from a pragmatic cluster randomised controlled trial |
| topic | Cardiovascular disease Rural health Primary health care Medical nutrition therapy Telehealth Dietitian |
| url | https://doi.org/10.1186/s12913-025-13096-8 |
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