Schiller M R, Arensberg M B, Kantor B
Medical Dietetics Division, Ohio State University, Columbus 43210-1234, USA.
J Am Diet Assoc. 1998 Jan;98(1):56-61. doi: 10.1016/S0002-8223(98)00015-7.
Ascertain views of home care administrators regarding the need for nutrition services in home care, current status and gaps in dietitian services, and obstacles toward expansion.
Mailed survey.
Members of the National Association for Home Care residing in California, New York, Pennsylvania, Ohio, and Texas. Of the 1,992 questionnaires sent, 402 (20.1%) were completed and used for data analysis.
Descriptive statistics.
Respondents gave high importance to nutrition (6.2 on a 7-point scale), and 39.6% estimated that more than half of their patients were malnourished. Most respondents reported using dietitian services, either as consultants (45.5%) or full-time (5.8%) or part-time (11.9%) employees. Nurses (85.5%) were listed most often as providers of nutrition services; also listed were dietitians (70.6%), pharmacists (17.2%), and physicians (11.2%). More than half of the respondents did not have, but would like to have, a dietitian serve as a nutrition consultant, prepare nutrition care plans, and provide nutrition counseling for patients and caregivers. Primary deterrents noted were lack of reimbursement by third-party payers and lack of physician request. Dietitian services ranked as having the highest value were patient education and counseling, medical nutrition therapy for specific conditions, development of nutrition care plans, staff in-service training, and nutrition assessments. Most home care administrators expected dietitian hours, services, and staff to increase during the next 5 years.
The growing home health care market is fertile ground for dietitians. To expand their role in home care, dietitians can position nutrition services as being vital to cost-effective, high-quality care; augment their skills in consultation, training, nutrition support, and outcomes research; strengthen collaborative ties with key home health care professionals; and advocate for Medicare coverage of medical nutrition therapy.
确定家庭护理管理人员对家庭护理中营养服务需求、营养师服务的现状与差距以及服务扩展障碍的看法。
邮寄调查问卷。
居住在加利福尼亚州、纽约州、宾夕法尼亚州、俄亥俄州和得克萨斯州的全国家庭护理协会成员。共发放1992份问卷，402份（20.1%）被完成并用于数据分析。
描述性统计。
受访者高度重视营养（7分制中得6.2分），39.6%的受访者估计其超过半数的患者营养不良。大多数受访者报告使用营养师服务，其中作为顾问（45.5%）、全职员工（5.8%）或兼职员工（11.9%）。护士（85.5%）被列为最常提供营养服务的人员；此外还有营养师（70.6%）、药剂师（17.2%）和医生（11.2%）。超过半数的受访者没有，但希望有营养师担任营养顾问、制定营养护理计划并为患者及护理人员提供营养咨询。指出的主要阻碍是第三方支付方不予报销以及医生未提出要求。被认为最具价值的营养师服务是患者教育与咨询、针对特定病症的医学营养治疗、营养护理计划制定、员工在职培训以及营养评估。大多数家庭护理管理人员预计未来5年营养师的工作时长、服务及员工数量会增加。
不断发展的家庭健康护理市场为营养师提供了广阔空间。为了扩大他们在家庭护理中的作用，营养师可以将营养服务定位为对具有成本效益的高质量护理至关重要；提升他们在咨询、培训、营养支持和结果研究方面的技能；加强与关键家庭健康护理专业人员的合作关系；并倡导医疗保险覆盖医学营养治疗。
