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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13 Providers of Nutrition Services
13 Providers of Nutrition Services
Pages 255-273
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Section IV Providers and Costs of Nutrition Services
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TERMS AND DEFINITIONS In reviewing specific providers, it must be recognized that terms such as "nutritionist," "dietitian," and "nutrition professional" can have varied definitions, however all refer to professionals who practice in the field of nutrition. In 1963, the Council on Foods and Nutrition of the American Medical Association defined the field of nutrition in the following manner: Nutrition is the science of food, the nutrients, and other substances therein, their action, interaction, and balance in relation to health and disease and the processes by which the organism ingests, digests, absorbs, transports, utilizes, and excretes food substances.
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Nutrition assessment is defined as "the evaluation of the nutrition needs of individuals and groups based upon appropriate biochemical, anthropometric, physical, and dietary data to determine nutrient needs and recommend appropriate nutrition intake, including parenteral and enteral nutrition." Nutrition counseling is defined as "advising and assisting individuals and groups on appropriate nutrition intake by integrating information from the nutrition assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status" (ADA, 1991~. TIERS OF NUTRITION SERVICES Nutrition services are provided throughout the continuum of care: in acute and ambulatory care, in skilled nursing and long-term care, in home health agencies, and in community-based nutrition programs.
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EDUCATION AND SKILLS NECESSARY FOR THE PROVISION OF NUTRITION THERAPY When determining who is qualified to be a nutrition professional, both academic background and supervised practice or experience are required (Glanz, 1985~. Nutrition professionals must have in-depth knowledge about the role of food and nutrition in the prevention, treatment, and progression of acute and chronic disease and, likewise, how disease and treatment affect food and nutrition needs.
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LICENSURE IN THE PRACTICE OF DIETETICS For many health professionals, state licensure can be relied on to identify individuals who meet minimum knowledge and skill requirements within a particular field. In the case of the nutrition professional, requirements for licensure vary among states and in the case of some states, licensure for nutrition professionals does not yet exist.
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confers the RD credential on an individual who has a minimum of a bachelor's degree from a regionally accredited college, meets specific academic and clinical requirements set by the ADA, and passes a national registration examination (CDR, 1999~. These academic and clinical requirements include extensive coursework and experience in nutrition sciences, including the role of nutrition in the prevention and treatment of disease; food science, including the effects of processing and preparation on nutrient composition; alternate feeding modalities; and counseling techniques needed to elicit behavior change.
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In most cases, standards are not available for nutrition education and counseling skills in the curriculum of the health care provider; therefore, it is difficult to generalize the reliability of the information provided to patients. The academic and clinical preparation in nutrition and the roles of various health professionals in providing nutrition services are described in Table 13.1.
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However, the Task Force found there was "insufficient" evidence to recommend for or against dietary counseling when performed by a primary care clinician, based on level III evidence. Hence, this report rates dietary counseling performed by a trained educator such as a dietitian as more effective than by a primary care clinician (see Appendix G)
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Registered Nurses The registered nurse coordinates patient care, works with the dietitian and other health care team members to identify nutrition problems, and reinforces the importance of nutrition interventions. The registered nurse may also provide less complex nutrition care, such as counseling on preventing chewing and swallowing difficulties or contributing to the nutritional assessment.
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While physicians and nurses spent significantly less time than dietitians in nutrition counseling, all study participants benefited from the coronary risk reduction information, whether it was provided by physicians and nurses or dietitians. Multidisciplinary Team Approach Although physicians, nurses, pharmacists, or other health professionals do not always have the knowledge of nutrition and food science that a dietitian has, each profession brings unique skills to the provision of nutrition care.
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However, if a patient has other chronic diseases that required more complex nutrition intervention, advice about calcium and vitamin D intake could be incorporated into the overall consultation provided by the nutrition professional. In addition to basic nutrition information, it is important that each health professional reinforce the importance of nutrition therapy prior to counseling with a nutrition professional and again at any follow-up visit.
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The nutrition professional should be involved in educating other health professionals regarding nutrition interventions and practical suggestions for dietary change that he/she can use to educate patients. With appropriate training, all health professionals should be involved in reinforcing the concepts of nutrition therapy provided by the nutrition professional.
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The registered dietitian is currently the single identifiable group of health professionals qualified to provide nutrition therapy. It is recognized that other health care professionals in particular fields may be qualified to provide nutrition therapy and should be considered on an individual basis as a reimbursable provider.
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1988. Selected allied health professionals' self-confidence in health promotion counseling skills and interest in continuing education programs.
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