Abstract:
Background: The Coordinated Care Program (CCP) in Poland involves the cooperation of a primary care physician with specialists, a nurse and a nutritionist. It includes prevention, diagnosis, treatment and patient education for selected diseases in the fields of cardiology, diabetology, endocrinology, pulmonology and nephrology. Since in Poland visits to a nutritionist are not reimbursed by the National Health Fund, an undoubted advantage of CCP is free access to consultations with a nutritionist. A patient can take part in up to 3 meetings with a nutritionist.
Aim: We would like to present the benefits and difficulties of the program from the perspective of a dietitian working in the CCP area, as well as share the results of a pilot study conducted among patients with cardiovascular disease enrolled in the CCP.
Methodology: The pilot study involved 110 patients with cardiovascular diseases. After applying the inclusion and exclusion criteria, 105 patients (average age 65 years) were qualified for further research procedures. The first visit (estimated time: 30-40 min) included: conducting an interview, analysis of eating habits, anthropometric measurements, determining the patient's needs, educational requirements and motivation, establishing recommendations, providing educational materials. At the next two visits, the effectiveness of the consultation is evaluated, the changes made are discussed, any difficulties are discussed, and the next course of action is determined (expected time per visit 15-30 minutes). Data were processed in Microsoft Excel and Statistica 13.3 for Windows. Results: Based on a pilot study (observation period 6 months) the following changes were observed among patients: decrease in blood pressure, improvement in glycemia among patients with associated type 2 diabetes, increased nutritional awareness, improvement in eating habits. Despite the breakthrough made in Poland in the context of free dietary consultations, undoubtedly, the number of visits intended for patients is still insufficient for their needs. The dietitian must be well organized in order to obtain the necessary information, identify the patient's needs and make all dietary recommendations. The average age of patients using this program is 65 years old and this patients need more time to assimilate new knowledge. In addition, these individuals most often face multiple disease entities, which requires combining several different nutritional interventions and presenting them in a simple and clear way. In addition, another difficulty is the lack of an open pathway with gastrointestinal diseases within the CCP. No less important is the problem of overweight and obesity occurring among these patients. The task of the dietitian is to set the objectives of a reduction diet, which is not the only way of solving the problem. It’s very important to identify the causes, at the root of which are often psychological problems related to overeating due to stress or failure to cope with emotions. In this regard, the dietitian's competence and tools are insufficient and the patient requires the support of a psychologist, who is missing from the team.
Conclusions: The Coordinated Care Program of the PCP is an opportunity for interdisciplinary patient care, providing a chance for faster diagnosis, treatment and nutritional interventions in the most common chronic diseases of the 21st century.
Audience Take Away:
- It can be used as an inspiration for introduction of similar programs in other countries. It shows importance of dietician and allows access to dietary management for those who normally would be not able to have it.
- Dietician is able to better understand and plan his visit regarding needs & problems of patients.
- Yes – diabetologist, cardiologist, endocrinologist.
- Yes. Reduces burden on the doctors by transferring part of their workload to diabetologists.
- It will provide new information needed for various statistical prognosis for Polish Ministry of Health and National Health Fund
