Increasing Nutrition Care Services to Out-Patients:

Abstract As a part of a larger ongoing state dietetic association Physician's Initiative Project, all registered dietitians in North Dakota (N=269) were surveyed via the mail to identify those who provide outpatient nutrition care services (n=67). A 90% response rate was seen. Dietitians were asked about adequacy of background information from physicians upon referral, and perceptions about the extent physicians rely on RD feedback. Dietitians were surveyed as to the number of visits that are medically necessary and the number of return visits that actually occur for individuals with diabetes, hypercholesterolemia and obesity. Dietitians were the least satisfied with initial medical background information and feedback supplied by physicians regarding hypercholesterolemia. Dietitians reported that they recommended follow up visits for 75% of patients with diabetes and 68% of obese patients but only 51% of hypercholesterolemic patients. Actual number of follow up appointments kept for each diagnosis was approximately half that recommended by standard medical nutrition therapy protocols or RD recommendations and were inadequate to produce significant changes in behavior. The most common reason sited for inadequate follow up was lack of patient motivation: diabetes, (53% of RDs cited), obesity (53%), hypercholesterolemia (47%). Dietitians need to stress the importance and benefits of adequate long term nutritional counseling to both physicians and clients. Improvement in intervention methods to better motivate clients may also be needed.