Providing high value care in high demand allied health services: An example of group education in chronic Kidney disease

Mrs Hilary Powlesland1, Mrs Belinda  Mason1, Dr  Riley  O’Donohue2, Dr  Adrian  Kark3, Dr  Lynda J  Ross1,4, Dr  Adrienne  Young1

1Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 2Department of Psychology, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 3Department of Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 4Menzies Institute Queensland, Gold Coast campus of Griffith University, Gold Coast, Australia

Rates of Chronic Kidney Disease (CKD) have increased by 50% over the past decade, placing significant demand on renal healthcare services. In dietetics, international CKD guidelines recommend individualised education to reduce excess dietary sodium intake. However, >80% of outpatients attending Brisbane metropolitan CKD service were identified as needing dietetic intervention for excess sodium intake, thus contributing to long wait-times. This study aimed to determine whether group-based sodium reduction education represents high value care: effective (reduces sodium intakes), efficient (reduces dietetic time and wait-times), and acceptable to patients. A single ninety-minute dietitian-led group-based education session was developed with input from the team psychologist, for patients with high sodium intake (score ≥50 on Scored Sodium Questionnaire-Short Form; SSQ-SF). The session included label reading, myth busting, food swaps and goal setting to increase knowledge and self-efficacy. Four pilot groups were conducted (Feb-May 2018). Sodium intake was measured pre- and six weeks post-group using the SSQ-SF, with comparisons made using Wilcoxen signed rank test. Data was collected on attendance, satisfaction (using validated Short Assessment of Patient Satisfaction) and wait-times. Twenty-three patients attended one of the four groups (30 referred; 77% attendance rate). A clinically and statistically significant reduction in dietary sodium intake was achieved in 78% patients (SSQ-SF score pre-group median: 70, IQR 56-96; post-group: 54, IQR 26-63, p<0.001). All patients reported being satisfied/very satisfied with the group. Dietetic education time was reduced by 30 minutes/patient, reducing wait-time by 12 weeks (pre:7 months; post:4 months), and thus 19 new dietitian appointments were created. Delivering dietetic education to CKD patients in a group setting represents high value care; that is, effective patient outcomes and high satisfaction for less health care resources, and opportunity to reinvest dietetic time for higher priority patients. Group education should be considered by allied health services experiencing high service demand.


Hilary Powlesland is an Accredited Practising Dietitian, and has worked for ten years across four major tertiary hospitals, with Bachelor Degrees in dietetics and business. She currently works as a Senior Dietitian at the Royal Brisbane and Women’s Hospital, with a special interest in the areas of Renal, Maternity and Bariatric Surgery. Hilary is the Chair of the Dietitians Association of Australia Queensland Engagement and Development Committee, and was last year presented with a DAA Award of Merit for her leadership and contribution over the past eight years.

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2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

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