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Dietitians in Primary Care: Success Stories and Opportunities in
Oregon’s New Healthcare Landscape
Mary Cluskey, PhD RD; Michelle Bump, MS RD; Lauren Cohen, Nova Elwood, Stephanie Moore,
Josie Riggall, and Eliza Wendel 1
COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Introduction:
• Primary healthcare in Oregon is changing with the
widespread implementation of Coordinate Care
Organizations (CCOs) and Patient Centered Homes
(PCMHs)
• The role of the dietitian in primary care is shifting as
this new system evolves.
• Few dietitians are currently working within this new
model, but the potential is great particularly as clinics
transition from fee for service to per patient, outcome-
based reimbursement.
• Dietitians improve clinical outcomes and reduce costs
related to physician time, medication, and hospital
admissions for patients struggling with obesity,
diabetes, lipid disorders, and other chronic diseases.
• The purpose of this project is to explore the
experiences of dietitians currently working within
PCMHs as well as opportunities for continued
improvement and involvement.
Methods:
• Convenience snowball sampling: OAND listserv email,
social media, announcements, and finding primary care
RDs through word of mouth
• In person and phone interviews with dietitians currently
working in the primary care setting (n = 8)
• Individually coded and analyzed interview responses
and found themes among participants
• Constant comparative analysis refined themes
revealed
Quantitative Data:
Success Stories:
“I remember a Latino patient in his 40’s with A1C
around 10 or 11. I went in and asked him what he
knew about his diabetes and how food affects blood
sugar. He was trying not to eat because he didn’t want
to have sugar in his blood. He was depressed and
struggling. He was trying so hard and wanted to know
why his efforts were failing. Instead of going over
everything at once, we discussed how food affects
blood sugars, foods containing sugar, and physical
activity, over a period of a few visits. The next time he
had his A1C checked it was around 7 or 8. He had
much more energy and depression was improving.”
Successes and Challenges: “There was a patient who was 17 and 100 pounds
overweight. He had come to the office a few times with his
mom for counseling. By his third visit he had lost 7 or 8
pounds, but decided he did not want to come back. A year
later I looked at my schedule and saw his name. I walked
out to the lobby to find him and could not see him
anywhere- he had lost 120 pounds. He came in to thank
me and show me the progress he made by making the
small changes I suggested.”
Conclusions:
• It is important for RDs working in primary care to track
outcomes to provide further evidence proving the
value of dietitians.
• Dietitians need to continue to advocate for
themselves as members of the primary care provider
team particularly in the early stages of healthcare
reform.
• As this model continues to evolve, a shift in focus
from disease management to preventative nutrition
has the potential to improve health outcomes.
• Although there are common successes and
challenges, there are multiple ways to effectively
integrate RDs into primary care clinics.
References:
• Academy of Nutrition and Dietetics. Integrating the
Registered Dietitian into Primary Care: Comprehensive
Primary Care Initiative. 2013.
• Jortberg B, Fleming M. Registered Dietitian
Nutritionists Bring Value to Emerging Health Care
Delivery Models. JAND. 2014; 114 (12): 2017-2022.
• Lemon C, Lacy K, Lohse B, et al. Outcomes Monitroing
of Health, Behavior, and Quality of Life After Nutrition
Intervention in Adults with Type 2 Diabetes. JAMA.
December 2004; 104 (12): 1805-1815.
Acknowledgements:
Thank you to the dietitians currently working in PCMHs in
Oregon, not only for your enthusiastic participation in this
project, but for paving the way for RDs in primary care
and making a difference in the lives of many. You are
pioneers in our field.