Changes in clinical dietetics: impact of cost reduction in healthcare systems

There is a lack of research regarding cost reduction activities in healthcare systems and their impact on clinical dietitians\u27 (CDs\u27) jobs and their perceptions about their professions. Purposes of this research were to identify changes in clinical dietetics due to cost reduction activities and to assess perceptions of CDs on improving levels of practice and educational and preprofessional preparation;There were two studies included in this research project. In the qualitative study, 16 clinical dietetic experts provided their observations and experiences related to changes in clinical dietetics and shared insights of improving the level of clinical dietetic practice and preparing future CDs. The quantitative questionnaire was developed based on the qualitative study results;In the quantitative study, 1,200 members of the American Dietetic Association (ADA) employed in acute care hospitals in eight ADA Area 2 states were selected as subjects. Subjects were asked to indicate their experiences of downsizing and to rate the importance of various items regarding improvement of practice and preparation of CDs;Among 342 respondents, \u3e75% of respondents reported reduced clinical dietetic staff, limited time for inpatient instruction, increased caseloads and high-risk patient intervention and referrals. Although CDs reported having limited time and increased caseloads, a few (\u3c15%) CDs indicated their responsibilities were delegated to support staff frequently. Some respondents reported the separation of foodservice and clinical nutrition departments. Some CDs indicated they are accountable to nursing administrators or medical doctors;For improving clinical dietetic practice, collaboration with other healthcare professionals, proficiency in more than one area of specialty and in computer technology, and passage of medical nutrition therapy legislation were perceived to be important. For educational preparation, importance of computer and oral presentation skills, enteral/parenteral nutrition, and evaluation of cost-effectiveness received high ratings. For preprofessional preparation, more practicum experiences and flexibility in job situations were perceived to be important;Recommendations were made to minimize negative impact of cost reduction, and to improve the level of practice and educational and preprofessional preparation for future dietitians. Further research was recommended to be conducted in other geographic regions and with dietitians with different job settings