Oral Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2023

Dietitian-led micronutrient management in a public bariatric surgery outpatient clinic: A mixed methods evaluation. (97405)

Carrie-Anne Lewis 1 2 , Joanne Hiatt 2 3 , Susan de Jersey 2 4 , Emma J Osland 2 3 , Ingrid j Hickman 1 5
  1. Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  2. Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  3. School of Human Movements and Nutrition Science, The University of Queensland, Brisbane, QLD, Australia
  4. Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  5. Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia

Background & Aim

There are opportunities to improve efficiencies in nutrition services after bariatric surgery by extending dietitian scope of practice to include micronutrient monitoring and management [1-3].  This study aimed to explore the multidisciplinary team attitudes and knowledge of bariatric surgery micronutrient management (pre- and postoperative care) and to evaluate the implementation of an extended-scope of practice dietitian-led model of care for micronutrient monitoring and management.

Methods

A mixed method study design included quantitative evaluation of micronutrient testing practices and deficiency rates. Qualitative reflexive thematic analysis was used to interpret multidisciplinary experience with micronutrient monitoring in a traditional and dietitian-led model of care. In addition, deductive analysis used Normalisation Process Theory (NPT) mapping of multidisciplinary experience with the implementation of the dietitian-led model of care.

Results

In the traditional model, a lack of quality evidence to guide micronutrient management, and a tension in trust between surgeons and patients related to adherence to micronutrient prescriptions were described as challenges in current practice. The dietitian-led model was seen to overcome some of these challenges, increasing collaborative, and coordinated, consistent and personalised patient care that led to increased testing for and detection of micronutrient deficiencies. Barriers to sustainability of the dietitian-led model included a lack of workforce succession planning, and no clearly defined delegation for some aspects of care.

Conclusion

An extended scope dietitian-led model of care for micronutrient management after bariatric surgery improves clinical care.  Challenges such as succession planning must be considered in design of extended scope services. 

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