Written by: Kelsey Schaffstall, Dietetic Intern for Hailey Crean Nutrition, LLC
Why telehealth could be here to stay
Since the beginning of the COVID-19 pandemic, video chatting is no longer only for speaking with your long-distance loved ones. Zoom calls with your coworkers, your therapist, your doctor, and even your personal trainer have quickly become the new normal. Almost overnight, countless industries have taken their services online. Although this has taken a toll on business that cannot exist in a virtual setting, some Americans have been surprised at how relatively smoothly this transition has gone. Here’s the thing, though. Virtual healthcare, better known as telehealth, has been on the rise for years and there is scientific data to back up its effectiveness, especially when it comes to nutrition counseling.
What are telehealth and telenutrition?
The Academy of Nutrition and Dietetics (AND) defines telehealth as ‘the use of electronic information and telecommunications technologies to support long-distance clinical health care’(1). By this definition, telehealth has a number of functions such as delivering patient and provider education and facilitating medical visits between people who are in different geographical locations.
The AND defines telenutrition as the use of electronic information and telecommunication to administer the Nutrition Care Process to patients in a remote location while abiding by the state licensure laws (1). It is important to note that telehealth and telenutrition are not just limited to video chats with your provider. Other tools that are frequently used in telehealth include email, communication through mobile apps, and data sharing with your provider via apps, trackers, and wearable devices. These tools allow for increased communication and real-time monitoring of patients compared to usual care.
What are the benefits of telehealth?
Traditional face-to-face visits pose many challenges to patients including access to transportation, traveling long distances to receive care, and clinic hours that are not compatible with long work hours (2). Telehealth and telenutrition can offer patients and practitioners flexibility in timing and location, making healthcare more accessible for those who are homebound, live in rural areas, or work long hours.
How does telehealth stack up to face-to-face visits?
Research has shown that telehealth services delivered by allied health professionals, including Registered Dietitians, are as effective as face-to-face interventions (3). Telehealth delivery by Registered Dietitians, in particular, has shown significant improvements in weight, BMI, A1C, blood pressure, and lipids (4).
In some cases, telenutrition has proven more effective than standard care. A 2016 meta-analysis of 25 studies reported that telenutrition for patients with chronic disease improved diet quality and dietary adherence when compared to traditional face-to-face dietary counseling (2).
Diabetes education via telehealth has also been widely studied, especially in rural populations. A randomized controlled trial examined a 1-year diabetes management program delivered by a dietitian and a nurse/certified diabetes educator and showed improved metabolic control and reduced cardiovascular risk compared to usual care (5). Another study conducted in rural Type 1 diabetic veterans found that specialty diabetes care via telehealth resulted in safe and effective care, high appointment attendance rates, and high patient satisfaction (6). This study also reports significant time savings for patients and cost savings for the hospital.
Because the evidence suggests that the quality of telehealthcare is the same as face-to-face visits, The American Telemedicine Association reports that more states are enacting telemedicine parity laws requiring private insurance companies to reimburse telemedicine at the same rate as in-person services. Medicare and Medicaid also expanded coverage for telehealth services in 2019 (1).
The future of nutrition care
For all of these reasons, telenutrition is a viable option for nutrition care moving forward. Registered Dietitians are uniquely able to provide care in a virtual setting, especially when it comes to nutrition education and counseling. As the body of evidence grows and reimbursement for telehealth services continue to improve, it is likely that ‘Zooming’ with your Registered Dietitian will become a new normal.
1. Peregrin T. Telehealth Is Transforming Health Care: What You Need to Know to Practice Telenutrition. J Acad Nutr Diet. 2019;119(11):1916-1920.
2. Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis. Am J Clin Nutr. 2016;104(6):1693-1702.
3. Speyer R, Denman D, Wilkes-Gillan S, et al. Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis. J Rehabil Med. 2018;50(3):225-235.
4. Dietetics AoNa. TN: TELENUTRITION INTERVENTIONS BY REGISTERED DIETITIANS (2012). Academy of Nutrition and Dietetics Evidence Analysis Library. https://www.andeal.org/topic.cfm?menu=4907&cat=4907. Published 2012. Accessed June 5, 2020.
5. Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ. TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare. Diabetes Care. 2010;33(8):1712-1717.
6. Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. Prev Chronic Dis. 2018;15:E13.