Value-based care offers a holistic approach to nutrition management
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The dietitian-patient relationship is an ongoing connection sustained throughout the health journey for patients with chronic kidney disease and end-stage renal disease.
While the historic fee-for-service model can be widely reactive in how it directs care, value-based medicine is proactive. That can be a major benefit in nutritional practice; the sooner we can interact and engage with patients about changing nutritional behavior, the better chance we have at improving outcomes. Simple steps can be taken to apply good nutrition practices to slow disease progression and empower patients to provide their own care – and truly understand and be prepared for the entire journey with kidney disease.
Early intervention
When we can intervene early, we coach patients on positive behavior change, which ultimately changes their perspective on nutrition and a healthy lifestyle. We are building trust, increasing awareness among our patients and caregivers and helping them activate steps they can take to help slow their disease progression to achieve the best possible quality of life.
Simply educating a patient on what is the best food for them to eat and what is not is unlikely to evoke lasting change that will benefit their health. Because we view CKD through a holistic lens, we understand food is cultural, social, individual, behavioral and vital to our everyday activities.
Kidney-friendly nutrition is not one-size-fits-all. We carefully navigate comorbidities, as well as more subtle nutrition factors, such as food psychology and mealtime behaviors, to deliver effective nutrition and education to our patients.
One area of support is use of medical nutrition therapy (MNT) for patients. MNT can play a key role in slowing disease progression and provide patients with optimal nutrition. We collaborate with the Kidney Nutrition Institute (https://kidneynutritioninstitute.org/), a leader in CKD nutrition, to ensure our dietitians are utilizing the most current evidence-based practices.
Nutrition coaching
Our renal dietitians (RDs) have a unique blend of clinical nutrition expertise and nutrition coaching to educate and drive behavior change. We have established workflows that connect patients to the RD early on and allow for consistent follow-up to help patients attain and maintain positive changes.
Our primary goal is patient engagement. Once engagement is established, patients feel more empowered to develop and follow through with their custom nutrition plan. The key is to establish realistic goals that can build over time.
When we develop our nutrition plans for patients with CKD, we begin with small changes, meeting them where they are. We guide them into a low protein diet to help slow disease progression. This often comes via a whole food plant-based diet. In some cases, there has been need or an order from physicians for a very low protein diet with Keto analogs. We offer a holistic focus that takes into account stress, sleep patterns and environmental factors that may be impacting nutrition.
Gaining trust with our patients is important because they know we are working directly with their physician to implement their care plan. Then, after identifying the patient’s unique set of needs, we dispatch education, resources and assistance. The key to trust is follow-through and consistency. We connect with patients and inform their physicians about their status between visits. We then follow up with the patients to make them aware of their progress.
Value-based care offers the opportunity to help patients improve not only their nutritional health but stay healthy. Good nutrition can be taught, but only behavioral change can make teachings effective.
- For more information:
- Valarie Hannahs, MS, RD, LD, is director of education and practice and the lead dietitian at Panoramic Health, and a member of the Editorial Advisory Board for Nephrology News & Issues. She can be reached at vhannahs77@gmail.com.
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