The activities of a dietitian-led gastroenterology clinic using extended scope of practice

Abstract

BackgroundExtending the scope of practice of allied health professionals has been a strategy adopted in the United Kingdom to address issues within the health system.Australia’s health system is currently undermined by similar issues, heightening government interest in adopting the extended scope health care model. The aim of the current study was to describe the activities and outcomes of a dietitian-led gastroenterology clinic which operated under an extended scope of practice model in an outpatient gastroenterology department at a tertiary hospital in regional Queensland, Australia, and to assess patient satisfaction with the initiative.MethodsA descriptive, cross-sectional case series undertaken over 50 clinics involving 82 category 2 and 3 patients with suspected/confirmed coeliac disease or inflammatory bowel disease; low haemoglobin; gastroesophageal reflux disease, or; malnutrition. Data was analysed using Microsoft Excel 2010, and presented as descriptive statistics.ResultsSixty out of 82 selected patients (median age 51 years) attended an initial appointment with the dietitian. Twenty-four review appointments were attended. Average waiting period for an initial appointment was 148 days (range 31–308 days). A total of 149 management strategies were provided, and 94 (63 %) of these involved the dietitian utilising extended scope of practice. The dietitian managed 47 (78 %) patients without need for gastroenterologist referral, and 25 (42 %) were discharged after dietetic management.Patients reported high levels of satisfaction with the clinic.ConclusionsSeventy-eight percent of category 2 and 3 patients referred to the gastroenterologist could be managed exclusively in the dietitian-led clinic. This extended scope model of care could potentially benefit the efficiency and acceptability of Australia’s public health system.

Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service

“…Most patients who receive dietetic care for these conditions report satisfactory control of symptoms and improved quality of life 19. In line with a previous study,13 majority of patients seen were managed exclusively within the DFGC and discharged back to their GPs with satisfactory resolution of symptoms. It is also essential that strategies continue to include effective diagnostic and management pathways for patients within the primary care setting to further help reduce wait lists.…”

“…Dietitians are well placed to operate under extended scope models of care within gastroenterology outpatient services, as a significant proportion of patients referred have functional gut disorders which may be managed with lifestyle and dietary modification 11 12. The activities of an extended scope gastroenterology dietitian clinic have been previously reported13; however, there are limited studies on the impact of such on medical specialist wait lists and patient wait times.…”

Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

“…With prevalence of malnutrition in Australian hospitals ranging from 23% to 42%, delays in increasing energy prescriptions because of missed or forgotten pathology testing could exacerbate these patients’ malnutrition. Studies examining the effect of registered dietitians performing activities classified as extended scope of practice, including pathology ordering and interpretation, have identified positive outcomes, including high levels of patient satisfaction, decreased workloads for specialists, decreased costs to the health‐care system and increased satisfaction levels for registered dietitians and other health‐care professionals involved . As the majority of respondents (90%, n = 143/159) desire the option to autonomously order pathology tests, and with colleagues in the United States already possessing the ability, it may be time to consider increasing the number of opportunities for registered dietitian‐led pathology ordering within Australian practice.…”

“…In comparison, registered dietitians working within the United States have the authority to order blood tests, provided their hospital and state legislation have approved this privilege . Similarly, within Queensland, one of the eight states of Australia, pathology can be independently requested and interpreted by the registered dietitian in a registered dietitian‐led gastroenterology outpatient clinic, under the jurisdiction of a consultant . However, no studies have been conducted examining the opinions and readiness of registered dietitians regarding pathology ordering in acute care, nor whether such rights influence RFS management.…”

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

“…The Australian dietetics profession has been active in this space over recent years and the number of advanced and extended practice roles and procedures introduced into the Australian health‐care setting continues to slowly grow. Published examples of the successful introduction of novel advanced and extended practice roles include a dietitian‐led gastroenterology clinic service, post‐pyloric feeding tube placement in critically ill patients, and dysphagia screening and intervention …”