• National Association Reports
    Moving Forward: Role of the Registered Dietitian in Primary Health Care – A Canadian Perspective
    Vol. 17 Issue 1
    Country: Canada
    Dietitians of Canada recently released a new role paper that articulates a national vision for dietetic services in primary health care (PHC) settings. Canada’s health care system is managed by the 13 provinces and territories, and the country faces major challenges in providing health care to its diverse population spread over Canada’s large geographic area. Developments in Canada parallel world-wide development and reform of PHC systems. Current thinking on such reform efforts was distilled in the 2008 WHO Health Report, Primary Health Care – Now More Than Ever (WHO, 2008). This latest report focuses on four main structural and management reforms to further develop and maintain sustainable PHC systems:

    * Universal coverage reforms to ensure universal access and social health protection
    * Service delivery reforms that are responsive to changing needs while producing better outcomes
    * Public policy reforms that integrate public health with primary care
    * Leadership reforms to improve system management. 

    While Canadians have universal access to medically necessary services in all jurisdictions, nutrition care is not currently defined in law as a medically necessary service. Dietitians are, however, increasingly employed by diverse organizations as members of inter-professional teams. The number and scope of such teams is increasing rapidly across the country, as provinces seek to reform the delivery of PHC. 

    It is well recognized in Canada that PHC is key to maintaining and improving Canadians’ health, and to the quality and sustainability of the health care system. Canada’s nutrition issues are linked to the major chronic diseases, exacerbated by Canada’s high obesity rates. These conditions can be prevented and managed with lifestyle interventions, including diet, reducing or eliminating the need for medications.

    Building on an earlier role paper (Dietitians of Canada, 2001); the new role paper describes the range and types of services Registered Dietitians provide in the many types of PHC organizations seen in Canada. Depending on the practice setting, Registered Dietitians in Canada may be responsible for a wide range of services:
    * In public health, Registered Dietitians practice population health planning, community-based needs informed research, health promotion and disease prevention. Public health dietitians provide reliable nutrition information to the public, educators, health professionals, policy makers, and the mass media.
    * In community health centres, physician led teams, and similar settings Registered Dietitians practice individual and group nutrition therapy, counselling, health promotion and disease prevention. 

    The organization of PHC services in communities across Canada varies widely, with limited or no access to specialist nutrition services in many PHC settings. Access requires adequate numbers of Registered Dietitians in PHC to ensure the health of Canadians. 

    Dietitians of Canada makes specific recommendations that provincial and federal policy decision-makers:
    * Develop and apply appropriate population needs-based funding mechanisms that support PHC nutrition services within their jurisdictions.
    * Establish effective systems that integrate nutrition services into all models of PHC.
    * Support systems for effective monitoring and ongoing evaluation of PHC nutrition services that ensure effectiveness and efficiency.

    Dietitians of Canada further recommends that professionals involved in implementation and evaluation of health services:
    * Establish long-range plans that ensure nutrition services match PHC needs of communities.
    * Implement appropriate population needs-based funding mechanisms that support PHC nutrition services within their jurisdictions.
    * Integrate nutrition services in all areas of PHC, including public health, telehealth, and other approaches to promote nutritional well-being.
    * Monitor and evaluate PHC nutrition services to ensure effectiveness and efficiency.

    Dietitians of Canada further recommends that professional associations, educators, researchers, practitioners and others involved in PHC development:
    * Promote strong inter-professional collaborative education and practice, including the expertise of Registered Dietitians as integral members of PHC teams.
    * Continue to develop and evaluate new models for inter-professional PHC nutrition practice, with a particular focus on prevention and treatment of Canada’s major chronic diseases. 

    The role paper is being used in a variety of advocacy contexts to support Canada’s PHC service delivery reform initiatives to increase access to care by promoting the Registered Dietitian role in the Canadian PHC context. The paper is available at:http://www.dietitians.ca/news/highlights_positions.asp 

    Dr. Paula Brauer
    Associate Professor
    Department of Family Relations and Applied Nutrition
    University Of Guelph
    Ontario, Canada