The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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11 Nutrition Services in Ambulatory Care Settings
11 Nutrition Services in Ambulatory Care Settings
Pages 213-224
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From page 213... ...
Nutrition services in ambulatory settings play a role in all three areas of prevention. REIMBURSEMENT FOR NUTRITION THERAPY IN AMBULATORY CARE At the present time, Medicare Part B covers medical and other health services which are incident to a primary care provider's services.
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From page 214... ...
Currently, the proposed regulations for diabetes self-management developed by the Health Care Financing Administration require that a registered dietitian and certified diabetes educator participate in the diabetes education program and that programs are accredited by the American Diabetes Association. Although the final regulations will not be released until early 2000, the proposed regulations include ten visits during the first year of diagnosis and one visit annually thereafter.
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From page 215... ...
In the acute care setting there was adequate support for nutrition professionals prior to implementation of the PPS. However, support for the nutrition professional in the ambulatory setting is presently inconsistent and inadequate.
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From page 216... ...
Nutrition services in ambulatory settings should include screening to identify individuals who need nutrition intervention and triaging to the most appropriate professional for care. Intervention can include basic nutrition education for disease prevention or more complex nutrition therapy.
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From page 217... ...
Since many individuals view botanicals and dietary supplements as food items, their use is often identified in the course of a comprehensive nutrition assessment. The role of food in enhancing health has also emerged with the concept of "functional foods" and "functional food components." Functional foods have been defined as foods that may provide a benefit beyond basic nutrition.
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From page 218... ...
Traditionally, primary care physicians and nurses have screened patients and provided basic nutrition information. Basic nutrition education is characterized as either a group or an individual interaction based on sound nutrition principles and is generally considered primary prevention.
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From page 219... ...
Refers patients to community services, food resources (e.g., food stamps, food pantries, home delivered meals) Collaborates or coordinates services with inpatient, long-term care, home care, and referring providers Social worker · Identifies patients in need of nutrition information or intervention · Collaborates with registered dietitian to plan for care in the continuum · Assists patients in obtaining needed food resources (e.g., food stamps, food pantries, home-delivered meals, Medicaid prior approval for nutritional supplements)
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From page 220... ...
EFFECTIVENESS OF NUTRITION THERAPY IN AMBULATORY SETTINGS Decreased length of stay and increased acuity levels in acute care settings have strengthened the argument that nutrition counseling is best conducted outside the hospital setting (Laramee, 1996~. For education to be effective, patients must be "ready to learn." Hospitalized patients are generally too ill to participate in self-management education.
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From page 221... ...
FUTURE AREAS OF RESEARCH The committee found limited research documenting the efficacy of nutrition therapy focused solely on primary prevention. Further research is needed to evaluate effectiveness of nutrition therapy in assisting the consumer to appropriately select food, dietary supplements, fortified or functional foods, and nutrition-related complementary and alternative medicine therapies that are consistent with the U.S.
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From page 222... ...
· Nutrition education is also important in the primary prevention of chronic disease. However, a variety of health care professionals such as physicians, nurses, and pharmacists should and do provide nutrition education in the context of routine preventive health visits or patient encounters.
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From page 223... ...
1994. Changes in health behaviors of older adults: The San Diego Medicare Preventive Health Project.
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From page 224... ...
1994. Older adult health behavior change in response to symptom experiences.
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