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PubMed2002

Information sessions for outpatients referred to a hospital Nutrition and Dietetic Service for cholesterol lowering advice.

AIM: To assess the feasibility of recruiting outpatients referred for cholesterol lowering advice to attend a 1-h evening information session provided by a hospital dietitian and to evaluate the service. METHOD: A Cholesterol Information Session was held on one evening each month between April and September 2000. Patients referred to the Nutrition and Dietetic Service for cholesterol lowering advice were sent appointments for these sessions by post instead of a one-to-one daytime appointment with the dietitian. At the session, the dietitian explained what cholesterol is and gave advice about the healthy eating and lifestyle changes needed to control it. Video material and literature were used to support verbal information. Questions were encouraged throughout the session. RESULTS: Thirty-four patients were sent appointments. Twenty-seven (79%) attended, 10 of whom were accompanied by a spouse/partner/carer/family member. All patients who attended completed evaluation forms. There was a high level of satisfaction with the sessions. Twenty-six patients (96%) said they liked the way the session was run and found the advice and videos helpful. Twenty-five patients (93%) preferred the evening appointment to a day time one. Patients who attended with a spouse/partner/carer/family member indicated it was helpful to them and the accompanying person. Feedback through patient comments was positive. The seven patients (21%) who did not attend the sessions made contact with the dietetic service. CONCLUSION: As a result of the positive outcome of the evaluation, the Cholesterol Information Session is continuing as a service to patients. It provides a facility outside the usual hours of outpatient services and can readily accommodate accompanying people. The information session uses the group format, which may be applicable to other specialist areas of the Nutrition and Dietetic service in the future, such as diabetes management.

After-Hours Care↗
PubMed2002

Position of the American Dietetic Association: nutrition services in managed care.

It is the position of the American Dietetic Association that medical nutrition therapy is an essential component of disease management and healthcare provided by managed care organizations, and that such care must be provided by qualified nutrition professionals. Compared with traditional fee-for-service reimbursement systems, managed care presents new opportunities for dietetics professionals. Until recently, the lack of billing infrastructure has handicapped nutrition providers who wish to bill for their services and has made it difficult to track the outcomes of nutrition care. With the publication of current procedure terminology codes for medical nutrition therapy (MNT) and the implementation of MNT benefits in Medicare part B for diabetes and nondialysis kidney disease, commercial payers, including managed care organizations (MCOs) are likely to implement or expand their coverage of MNT. A large body of evidence supports the efficacy and cost-effectiveness of MNT coverage within managed care plans. This evidence includes cost analyses of conditions treated by MNT, and clinical trial data confirming the efficacy of MNT in improving patient outcomes. MNT is also an important part of national standards of care for many chronic disease conditions. Based on evidence supporting the role of MNT in improving patient outcomes, the Institute of Medicine (IOM) recommended that MNT services be reimbursed by Medicare when patients are referred by a physician. Provision of appropriate MNT can also help MCOs meet accreditation and quality standards established by entities such as the National Committee for Quality Assurance and the Joint Commission for the Accreditation of Health Care Organizations. Much of the work required to secure a place for MNT in MCOs will be done at the practitioner level, by nutrition professionals themselves. Registered dietitians must market MNT to their customers in managed care by addressing the needs of each player. By emphasizing the importance of MNT and other cost-effective forms of preventive care and disease management, MCOs will be well positioned to improve population health at modest cost.

Cost-Benefit Analysis↗
PubMed2004

Using interpretative phenomenological analysis for public health nutrition and dietetic research: a practical guide.

The present paper introduces interpretative phenomenological analysis (IPA) as a framework for analysing qualitative research data collected for public health nutrition and dietetic research studies. The theoretical roots of IPA have been set out briefly in order to help researchers decide whether the approach is relevant for them and their particular research questions. IPA can be used to analyse data from one-to-one interviews in order to develop 'thick descriptions' that may help illuminate human experience. IPA can also be used to develop theories and/or models, which could help inform policy. The main body of the paper describes the analytical techniques and procedures used to achieve both outcomes in a practical way, using examples from the author's own research. In the following paper Krueger's methods for analysing focus group data are set out for comparison. It is hoped that these papers will empower researchers with little experience of qualitative research to develop confidence with qualitative data analysis. In addition, it is hoped that the material will stimulate debate amongst more experienced qualitative researchers from a public health or dietetic background.

Data Interpretation, Statistical↗
PubMed1988

Research methods in nutrition and dietetics: design, data analysis, and presentation.

Most problems in practice may be addressed through research. To show the applicability of research to all areas of nutrition and dietetics, seven types of research designs are discussed in this article: qualitative research; case series and surveys--both categorized as descriptive research; and experimental design, quasiexperimental design, cohort (follow-up) studies, and case-control studies--the four of which are categorized as analytical research because each design tests hypotheses of causal relationships. Sample size, subject selection, and statistical analysis and interpretation are discussed as appropriate to each research design. Numerous examples are presented, along with the basic research designs. Each section and subsection is numbered so that the article can serve easily as a reference and its component parts can be accessed readily. Research provides answers to questions and, generally, raises further questions that future research can address. Among the benefits of well-designed research are answers to clearly stated research questions, useful comparisons between options, information to guide evaluations of protocols, and data to document and support one's professional activities and one's staff.

Clinical Trials as Topic↗
PubMed1997

Use of dietetic-specific nutritional diagnostic codes in clinical reasoning relevant to the nutritional management of core clinical outcome indicators in hemodialysis patients.

The Health Care Financing Agency (HCFA) has recommended conscientious monitoring of four core outcome indicators (anemia, albumin, treatment adequacy, and hypertension) by the end stage renal disease (ESRD) health care team. Dietetic-specific nutritional diagnostic categories (D-S NDCs) can be a powerful tool in guiding renal nutrition specialists through the clinical reasoning required to diagnose and clinically correct nutrition-related problems in hemodialysis (HD) patients. The purpose of this article is to portray one clinician's dual use of D-S NDCs to identify the nutritional problem responsible for poor performance and determine nutritionally treatable causes. Although four indicator-specific sets of D-S NDCs commonly used in the nutritional assessment of anemia, albumin, treatment adequacy and hypertension were identified and referenced, seven codes were consistently repeated. These D-S NDCs were (1) altered nutritional biochemistry integrity; (2) absence of/limited nutritional service; (3) deficit in nutrition knowledge; (4) imbalance of nutrient/fluid; (5) nutrition misinformation; (6) toxicity of nutrient/nutrient end-product; and (7) possibility of developing a specific disease. Thus, in ESRD, use of D-S NDCs shows the implicit role of the registered dietitian in disease prevention, management of altered nutrient disposition, and patient education.

Dietetics↗
PubMed1996

Position of the American Dietetic Association: nutrition education for the public.

In keeping with the ADA's mission, which is to be "the advocate of the dietetics professional serving the public through the promotion of optimal nutrition, health and well-being," ADA supports nutrition education delivered by qualified dietetics professionals as essential for the public to achieve and maintain optimal nutritional health. Nutrition education serves as a foundation for achieving notable advances in the nutritional status of the public. To be effective in creating actual behavior change, nutrition education programs must be developed on the basis of the needs, behaviors, motivations, and desires of target audiences. A wide variety of strategies have been identified as effective in helping to increase awareness, enhance motivation, and foster and sustain behavior change. A multiple reinforcing strategy, by which consumers are repeatedly reached with consistent messages, may support individual nutrition education efforts best. It is clear that more research is necessary to identify the needs, behaviors, motivations, and desires of target audiences. Developing and testing cost-effective methods for evaluating the effectiveness of nutrition education programs along with comparative models to investigate the effectiveness of alternative educational interventions are also needed. Practitioner involvement in nutrition education research is vital to gain maximum benefit.

Dietetics↗