Bond University Research Repository Dietitians Australia position statement on telehealth Kelly, Jaimon T; Allman-Farinelli, Margaret; Chen, Juliana; Partridge, Stephanie R; Collins, Clare; Rollo, Megan; Haslam, Rebecca; Diversi, Tara; Campbell, Katrina L Published in: Nutrition and Dietetics DOI: 10.1111/1747-0080.12619 Licence: CC BY Link to output in Bond University research repository. Recommended citation(APA): Kelly, J. T., Allman-Farinelli, M., Chen, J., Partridge, S. R., Collins, C., Rollo, M., Haslam, R., Diversi, T., & Campbell, K. L. (2020). Dietitians Australia position statement on telehealth. Nutrition and Dietetics, 77(4), 406- 415. https://doi.org/10.1111/1747-0080.12619 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. For more information, or if you believe that this document breaches copyright, please contact the Bond University research repository coordinator. Download date: 07 Oct 2021 Received: 17 April 2020 Revised: 11 May 2020 Accepted: 12 May 2020 DOI: 10.1111/1747-0080.12619 INVITED POSITION PAPER Dietitians Australia position statement on telehealth Jaimon T. Kelly PhD1 | Margaret Allman-Farinelli PhD2 | Juliana Chen PhD2 | Stephanie R. Partridge PhD3 | Clare Collins PhD4 | Megan Rollo PhD4 | Rebecca Haslam PhD4 | Tara Diversi AdvAPD | Katrina L. Campbell PhD1 1Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Abstract Gold Coast, Australia It is the position of Dietitians Australia that clients can receive high-quality and 2Charles Perkins Centre, Discipline of effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via Nutrition and Dietetics, School of Life and telehealth. Outcomes of telehealth-delivered dietetic consultations are comparable Environmental Sciences, The University of Sydney, Sydney, Australia to those delivered in-person, without requiring higher levels of additional training 3Westmead Applied Research Centre, nor compromising quality of service provision. Dietitians Australia recommends Faculty of Medicine and Health, The that policy makers and healthcare funders broaden the recognition for telehealth- University of Sydney, Sydney, Australia delivered dietetic consultations as a responsive and cost-effective alternative or 4Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, complement to traditional in-person delivery of dietetic services. The successful Faculty of Health and Medicine , The implementation of telehealth can help to address health and service inequalities, University of Newcastle, Callaghan, Australia improve access to effective nutrition services, and support people with chronic dis- Correspondence ease to optimise their diet-related health and well-being, regardless of their loca- Jaimon T. Kelly, Menzies Health Institute tion, income or literacy level, thereby addressing current inequities. Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia. KEYWORDS Email: [email protected] chronic disease, diet, digital health, nutrition, telehealth 1 | BACKGROUND countries, has an ageing population, which presents a sig- nificant challenge for the healthcare system. Together these Nutrition-related chronic diseases are the leading cause of will drive up healthcare expenditure and present a multi- ill health in Australia.1 Within the next 5 years, it is esti- tude of additional societal, geographical and workforce mated that over 75% of Australian adults will be living with challenges for the healthcare system to manage.4 overweight or obesity.2 One in two Australian adults have a Telehealth-delivered nutrition consultations offer a flexible chronic disease, with over seven million (35% of the modality to provide effective and cost-effective medical nutri- Australian population) living with nutrition-related chronic tion therapy (MNT), regular monitoring and support to the disease, including type 2 diabetes, cardiovascular disease, large numbers of people in the community requiring dietetic obesity, diet-related cancer, chronic kidney disease and services, in particular those with obesity5 and nutrition-related mental health conditions.1,3 Australia, like many developed chronic disease.6,7 According to the World Health Organisa- tion, the term “telehealth” referstotheremotedeliveryof Authors are members of the Dietitians Australia Telehealth Working health services using information and communication tech- Group nologies to exchange health information, either synchronously This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2020 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia Nutr Diet. 2020;1–10. wileyonlinelibrary.com/journal/ndi 1 2 KELLY ET AL. (ie, two-way communication in real time; e.g. telephone and modelling studies.19-21 Further, an updated search (to April videoconference consultations) and/or asynchronously (ie, 2020) using the search terms reported in Kelly et al6 one way communication at any time; e.g. text-messaging and screened against additional criteria, including (a) telephone web-portals).8 Digital health modalities (encompassing or videoconference diet intervention and (b) delivered by a telehealth) also include the remote delivery of nutrition inter- dietitian. A meta-analysis was performed on selected die- ventions via electronic health (eHealth) modes, such as web- tary outcomes. The effect of telehealth-delivered dietetic based programs, software programs and a range of mobile services is arranged into five sections: (i) weight manage- health (mHealth) options, such as smartphone applications ment for people who are overweight or obese; (ii) chronic (apps), text messaging programs and wearable devices. disease populations; (iii) malnutrition; (iv) emerging tech- Many Australians cannot access dietetic services due to nologies; and (v) cost-effectiveness. economic, geographic and sociographic barriers. There is a high concentration of dietitians located in urban, affluent areas while communities experiencing high rates of people 3 | TELEPHONE-DELIVERED living with overweight and obesity and type 2 diabetes DIETETIC CONSULTATIONS FOR mellitus are located in more disadvantaged urban suburbs WEIGHT MANAGEMENT and rural areas.9 Furthermore,oneinfourpeoplewithor at risk of chronic disease fail to attend in-person consulta- There is a growing evidence base supporting the effect of tions in community-based and outpatient clinics, contribut- telephone-delivered weight management services for peo- ing to substantial healthcare resource waste.10 Some of the plewhoareoverweightorobese(bodymassindex major reasons people fail to keep appointments in the com- (BMI) ≥25 kg/m2). Two randomised controlled trials munity are incurring high indirect costs associated with in- (RCTs) (2013, n = 295 participants22; and 2011, clinic consultations (e.g. time away from work, travel and n = 415 participants23) showed that weight loss in peo- costs of parking), cancellations and re-bookings, and frus- ple with overweight and obesity is similar regardless of trations associated with lengthy waiting times.10,11 whether the dietetic consultation is delivered by in- Innovative health solutions can be used to create proac- person mode, ad-hoc or via telehealth. tive, effective and sustainable services to suit growing needs Compared to traditional care, a recent systematic review and demands on the healthcare system.12 While these needs with meta-analysis (2019, n = 9 RCTs) concluded that are recognised,13 historically models of care have fallen short telephone-delivered weight management interventions with meeting these needs. In March 2020, the Australian resulted in a significant decrease in BMI for people with over- Government temporarily expanded access to Accredited weight or obesity of −0.46 kg/m2 (95% CI −0.73, −0.19).18 Practising Dietitians (APD) for Medicare Benefits Schedule Recent RCTs and other study designs yield additional evi- (MBS) items to deliver telehealth services to Australians with dence. An RCT (2016, n = 11 participants) in people with an eligible chronic disease management plan, including vid- overweight or obesity, referred by their primary care physi- eoconference and telephone consultations, in response to cian, found that weekly telephone lifestyle counselling by die- the COVID-19 pandemic.14 These changes have encouraged titians for 6 months, and second weekly calls for the a reframe of traditional models of healthcare delivery into following 6 months, resulted in significant weight loss. At virtual modalities delivered remotely that can continue well 12 months, 47.8% of patients in the treatment group had lost after the immediate COVID-19 crisis.15 5 % of their body weight vs 11.6% in the control group The aim of this position statement is to outline the (P < .01). The treatment group also significantly increased clinical- and cost-effectiveness of telehealth-delivered die- their moderate to vigorous physical activity compared with tetic consultations, and to translate this evidence to prac- the control group (+126.1 minutes vs +73.7 minutes). While tice and policy recommendations.