Perspectives on Diabetes Care

How to Make a Successful Transition to Virtual Nutrition Counseling

Apr 27, 2020, 09:00 AM

by Lorena Drago, RD, MS, CDN, CDCES

As the COVID-19 pandemic has upended everyday life, registered dietitian nutritionists (RDN) are moving to virtual visits. In a few weeks, nutrition professionals working in healthcare organizations and in private practices have had to adapt to a new normal.

This blog post presents practical tips to create a meaningful and successful experience for both clinician and client during virtual visits.

Before the virtual nutrition visit: Prepare, prepare, prepare

For the client

Create a client virtual visit guide that addresses the following:

• Technology: Explain how to use web or other electronic-based communication devices that will be used during the visit. Encourage the use of a tablet or computer so you can screen-share documents and teaching tools. Provide a telephone number that they can use if there are technical issues. Ensure clients can access their electronic health records and know how to check-in for the visit.
• Insurance benefits: Verify the individual’s virtual visit is covered.
• Forms & questionnaires: Describe each form the individual will need to complete, read and sign; for example, consent forms, HIPAA forms, nutrition assessment forms, etc. Provide forms in the individual’s preferred language.
• Medications & glucose results: Request the client’s glucose results, if they are monitoring at home, and a list of current medications.
• Location: Ask your client to find a comfortable space without interruptions. Ask them to bring questions as well as a pen and paper for notes.
• What to expect during a virtual visit: Explain what will occur during the visit from check-in to check out.

For the nutritionist

• Privacy and confidentiality: If you have a private practice, use HIPAA-compliant electronic medical records and electronic communications. There are a plethora of platforms with different features and at different price levels, to meet the needs of registered dietitians. Some of the most popular electronic medical records for RDNs are: Healthie, Practice Better, Kalix, Simple Practice, Practice Fusion and Doxy.me for televisits.  
• Reminder calls: Remind your client of the visit and confirm they feel comfortable proceeding with the virtual visit.
• Nutrition assessment forms: Upload nutrition assessment forms, including a 24-hour intake form/food frequency form.
• Ask meaningful questions: Ask the individual what the expectation for the nutrition visit is. Here are some examples:
  • What are 1-2 questions you would like answered before the end of the nutrition visit?
  • What is most challenging about maintaining a healthy diabetes eating plan?

• Teaching techniques: Consider using the flipped classroom approach. It is a pedagogy-first teaching approach where the course materials are provided first and the visit is used for application and discussion. Email or upload educational videos and curated diabetes and nutrition education materials.

During the nutrition counseling visit

• Create interactive handouts: Here are some ideas to make handouts more interactive to encourage application of fresh material.
  • If you are teaching an individual about carbohydrates, use their dietary history assessment. Ask, “Can you tell me which of the foods are good carbohydrate sources? Based on our conversation, what are some ways that you can change the amount of carbohydrates in your meal? What do you think you can do to enhance the quality of the meal?”

• Be yourself: Whether in person or virtual, connect with your client. Orient them at the beginning of the visit and set expectations. For example, tell them the duration of the visit and remind them to have a pen and paper to write key points discussed during the visit.
• Meaningful nutrition education: Focus your visit on what they want to know, already know and need to know.
  • Client wants to know: These questions should be posed during the nutrition assessment questionnaire. It can be reinforced during the visit to ensure that their questions have been interpreted correctly.
  • Client already knows: Test their knowledge in a nonthreatening way. For example, when teaching about carbohydrates, I start by describing what a carbohydrate is. Then, I ask if they have heard about carbohydrates and to enumerate foods that are sources of carbohydrates. To test what they know, I share the screen and use a handout with about nine foods with and without carbohydrates and ask them to identify those with carbohydrates; for example, fish, fat-free milk, whole milk, oats, olive oil, whole-wheat bread, brown rice, white rice and walnuts. In a brief amount of time, I know what the individual knows and I can now focus on what they need to know.
  • Client needs to know: Once you’re aware of what the individual needs to know, prepare the handouts you will use. You can create your own handouts or use the Academy of Nutrition and the Association of Diabetes Care and Education Specialists’ handouts and teaching materials.

• If you have shared educational materials with the client before the visit or during the visit, dig further. Ask, “What new information did you learn after watching the video/reading the handout? What did you already know? What was useful that you could put into practice right now? What was difficult to understand/do?”
• Use teach-back: Ensure that you have explained what is important and in a way they’ll understand. Ask, “Can you tell me or show me in your own words?” followed by the topic in which you want to confirm understanding.  
• Establishing goals: Complete your section by establishing collaborative goals.
• Follow up: Schedule a follow-up appointment. 

ADCES has compiled a variety of resources to help you evaluate your needs when launching telehealth services. Find them at DiabetesEducator.org/Telehealth.

About the Author:

Lorena Drago, RD, MS, CDN, CDCES, maintains her own private practice and is the owner of Hispanic Foodways, which specializes in creating culturally and ethnically-oriented nutrition and diabetes education materials.

ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

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