Why Nutrition Belongs in Your Primary Care Practice

Easy access to a registered dietitian is especially important for many patients these days. While nutrition services might once have been overlooked in the medical community as a contributor to better health outcomes, they’re now in the spotlight as more patients are taking GLP-1 medications like Ozempic for diabetes and Wegovy for weight loss.

These drugs can work wonders - but they work best when dietitians help patients understand their medications, handle side effects like malnutrition and constipation, and set appropriate expectations for weight loss and health outcomes.

As the increased use of GLP-1s is bringing more focus on treating diabetes, obesity and related conditions, primary care practices would do well to offer or expand nutrition services for patients. And not just for these conditions. There are many reasons why primary care integration with nutrition services makes sense, including:

Nutrition services give patients another reason to choose - and stay with - your practice. Patients have clearly stated their preference for convenient care that meets their individual needs, and for many, this includes the services of a dietitian or licensed nutritionist. If they can find one who’s employed by or affiliated with your practice, it can lead to increased patient satisfaction and make it more likely that they’ll stay with you for the long haul.

Working with a dietitian can lead to better health outcomes. Nutrition services, when paired with conventional physician-led care, have been shown in multiple studies to lead to improvements in many health measures. For example, research has shown that medical nutrition therapy delivered by a registered dietitian can reduce A1c (glycated hemoglobin) by as much as 2% for those with diabetes. In another study, researchers i)n Denmark found that adding a dietitian to hospital discharge services in elderly patients contributed to improvements in protein intake and significantly lower hospital readmissions over a six-month period.

Primary care practices can use nutrition services for a multitude of health conditions and patient needs. In addition to diabetes, pre-diabetes and weight management, the list includes heart disease, chronic kidney disease, autoimmune conditions, gastrointestinal conditions, high cholesterol, metabolic disorders, eating disorders, sports nutrition, and general needs such as adopting a vegetarian or vegan diet.

You’re not locked into one way of doing it. At least three models exist for primary care practices to integrate nutrition services. These models give practices flexibility to adopt nutrition services and add capabilities as the practice grows. They include:

• Full-time employment of registered dietitians. This establishes the tightest possible integration between primary care and nutrition services, which leads to increased patient trust as physicians can introduce the patient to a dietitian in the office.

• Contracting with a nutrition services practice or individual. Paying an independent contractor when needed is more flexible and less expensive for smaller practices, yet still allows the physician to call on nutrition specialists when needed.

• Referrals to a nutrition services practice. The primary care practice refers patients to an in-office or nearby dietitian as a convenience for patients but does not get reimbursed.

It’s cost-effective. Since most insurance plans cover nutrition counseling, practices are reimbursed. Patients can ask for nutrition services on their own without a referral, except for Medicare, which requires a physician referral.

At Alo and Avance Care, nearly all our 35+ locations across North Carolina offer in-house nutrition services. We’ve found that many of our patients regularly use these services. We employ 16 registered dietitians and are planning to hire four to five more by the end of 2024.

Success stories abound. In one recent case, a patient with type 2 diabetes was referred for our medical nutrition therapy and diabetes education. Our registered dietitian worked in concert with the patient’s primary care physician to create a plan that included a combination long-acting insulin and GLP-1 injectible falling under the patient’s $25 per month Medicare copay for insulin. The patient’s A1c level has since decreased from 8.6 to 7.1, an appropriate target for her age and condition.

Another recent case involved close collaboration between Avance Care’s primary care physician, nutrition services and behavioral health services for a patient with a history of an eating disorder as well as general anxiety disorder and depression. During assessment by the registered dietitian, the dietitian urgently contacted the primary care physician, who got the patient to the emergency department. The patient has since improved under ongoing care by the dietitian and an Avance Care behavioral health therapist.

These and other examples show the value of primary care practices recommending nutrition services for patients when appropriate. While there are many ways for primary care physicians to achieve this, our experience shows that tight integration of primary care and nutrition counseling is the most effective way to arrive at better health outcomes and higher patient satisfaction.