Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services

Abstract

The aim of the present study was to investigate the participation and weight and waist circumference outcomes of patients with type 2 diabetes (T2D) receiving Medicare-subsidised dietetic services. A prospective observational study was conducted between January and September 2011 involving three private practice dietitians who provided services at 11 medical centres in south-east Queensland. All patients with T2D who were referred by their general practitioner (GP) to one of the dietitians as part of their team care arrangements were asked to participate. Participants' attendance at consultations was recorded for the study duration. The dietitian collected weight and waist circumference measures at each consultation. In all, 129 participants (mean age 58.9 ± 15.7 years; mean body mass index 32.2 ± 5.6 kgm⁻²) were included in the study. The most frequent number of consultations allocated to a dietitian was two. Small, but significant reductions in bodyweight (1.9 ± 2.9 kg; P ≤ 0.05) and waist circumference (2.0 ± 4.8 cm; P ≤ 0.05) were observed from the initial to final consultation. Participants who attended more than two consultations lost significantly more weight than those who attended two consultations only (3.7 ± 4.2 vs 1.1 ± 1.6 kg, respectively; P ≤ 0.05). Almost one-third of participants (n=38; 29%) did not complete the allocated number of consultations available through their referral. Modest weight and waist circumference reductions are achievable for patients with T2D receiving Medicare-subsidised dietetic services. The clinical significance of these reductions requires further investigation. Patients who attend more consultations with a dietitian may experience further improvements in weight and waist circumference outcomes. However, many patients do not complete the number of consultations allocated. Further research is required to explore the determinants of attendance at consultations in order to maximise potential improvements in health outcomes for patients receiving Medicare-subsidised dietetic services.

Using synchronous distance education to deliver a weight loss intervention: A randomized trial

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Time and financial outcomes of private practice dietitians providing care under the Australian Medicare program: A longitudinal, exploratory study

“…A 2010 qualitative study suggested the CDM scheme wastes public resources, as patients with private health insurance are referred under the scheme, and some patients may return to public services after their consultation cap is reached, duplicating assessments and treatments . Additionally, only one prospective observational study has investigated patient outcomes of dietetics services under the Medicare CDM program, and showed only modest improvements in weight and waist circumference in patients . The capacity of GPs to provide nutrition care is still much greater than dietitians .…”

“…19 Additionally, only one prospective observational study has investigated patient outcomes of dietetics services under the Medicare CDM program, and showed only modest improvements in weight and waist circumference in patients. 20 The capacity of GPs to provide nutrition care is still much greater than dietitians. 21,22 Therefore, instead of increasing schedule fees for allied health services, it could be argued that it would be more economically efficient to put these funds towards supporting GPs and practice nurses to provide nutrition care.…”

Decade of Medicare: The contribution of private practice dietitians to chronic disease management and diabetes group services

“…One prospective observational study conducted over nine months found modest changes in weight and waist circumferences for CDM patients with type 2 diabetes. 24 However, there was a high rate of non-attendance (29%) over time. Another recent qualitative investigation found that some CDM patients were motivated by feeling an obligation to attend consultations with allied health professionals due to the rebates available to them.…”

“…Despite a continued increase in the overall utilisation of CDM services, minimal evaluation has occurred regarding patient outcomes. One prospective observational study conducted over nine months found modest changes in weight and waist circumferences for CDM patients with type 2 diabetes . However, there was a high rate of non‐attendance (29%) over time.…”