A pilot project undertaken by the Abbotsford Division of Family Practice demonstrated the valuable role that registered dietitians can play in primary care teams. After identifying that approximately 38,000 patients, which is 27% of the community, suffered from diet-related chronic diseases such as diabetes and hypertension, Abbotsford Division launched a pilot project to provide 10 primary care clinics in its community with access to registered dietitians for a 19-month period.
Implemented between September 2015 and March 2017 in partnership with Fraser Health Nutrition Services, the project involved four part-time dietitians (equivalent to 1.0 FTE) providing service to approximately 730 patients of more than 30 GPs. The project had a positive impact on patients across the dietary spectrum with healthier weights being achieved by overweight and underweight patients. Patients surveyed were overwhelmingly positive, citing key benefits including shorter wait times, one-on-one nutritional counselling, and ongoing support in setting realistic, achievable goals.
Dr Caroline Cook, one of the participating physicians, shared a clinical example of a young underweight 17-year-old patient with a history of dietary challenges and failed treatments. The patient had a very low BMI, was consistently missing school, and “would not go to an eating disorder clinic in the city and would only agree to come to my practice." After introducing the patient to an onsite dietitian the patient visited the office every two weeks. The dietitian frequently checked in with Dr Cook to discuss concerns and process. Dr Cook reported that her patient is “stable, has gained weight and is now doing really well. She’s 18 and graduating from high school this year."
Another example of patient success was when one 65-year-old sedentary woman diagnosed with diabetes, hypertension and struggling with post-retirement depression began seeing the dietitian at her local doctor’s office. Under the dietitian’s guidance she was able to transition to a healthier diet and increased her activity level. She even had the opportunity to fulfill one of her dreams of joining a competitive dragon boat racing team and won a gold medal.
The Abbotsford Division of Family Practice’s pilot project demonstrated a team-based approach to care that enabled providers to effectively support patients as well as each other. In addition to the positive patient feedback, the participating physicians appreciated the amount of time saved counselling complex patients and the ease of access to the dietitian. Currently, the Abbotsford Division is looking into new ways of evaluating the work to demonstrate sustainability and prove its business case so these learnings can be integrated into its next project.