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Yes the webinar has been recorded and is available on both the AYMES and BDA websites
Yes, a certificate of attendance is available via the link below the webinar on the AYMES website
We haven’t made the slides available as all the content is available in the webinar recording
Telehealth/digital care may not be suitable for all groups of patients, it is an alternative to and not a
replacement of a face to face consultation. Professional and clinical judgement should be applied.
Whilst many older adults may not be computer literate or have access to the right technology, some older
adults are happy to engage in this way and see this as a viable alternative to a face to face consultation. Giving patients choice about how they receive care is important.
If working in private practice it is the responsibility of the company (if you work for a private company)
or clinician (if you run your own business) to check GDPR compliance of the software that they choose to use. You can check their data policies or contact the provider directly. Other elements of information governance to consider includes ensuring that unauthorised personnel are not able to view your computer screen containing patient identifiable information or listen to patient calls. You will also need to consider safe storage of documents if working remotely.
It is always best to set the ground rules up front and gain necessary consent from patients at the outset
so they know what to expect. The process would be very similar to establishing confidentiality in a face-to- face group setting.
Telehealth/Digital Care is not designed to completely replace face to face appointments. Patients should
be offered a choice of how they are seen. Dietitians should use professional and clinical judgement where necessary.
This would be extremely difficult to assess in any group setting. It maybe worthwhile also using one to
one virtual appointments initially to complete a personalised assessment to include this prior to a group session.
You can find out more about GDPR on the BDA website here: https://www.bda.uk.com/practice-and-
education/nutrition-and-dietetic-practice/digital-practice/electronic-health-records.html
Working in a new way always requires a little adjustment. Calls in telehealth can be very much back-to-
back as you are less likely to experience DNAs. Plan to expect this and allow sufficient breaks in your day, e.g. in the morning and afternoon in addition to your lunch. Remember to allow time for documentation too.
It is the responsibility of the clinician or company to determine the GDPR compliance of the software they choose to use. You can do so by accessing their data policies or contacting the provider directly. Extra measures of security include using patient numbers instead of patient names and password protecting or encrypting documents.
It is the responsibility of the clinician or company to determine the GDPR compliance of the software they choose to use. You can do so by accessing their data policies or contacting the provider directly. Extra measures of security include using patient numbers instead of patient names and password protecting or encrypting documents.
Video or telephone consultations can work well for people with disordered eating. It is likely that
traditional online coaching may be unsuitable for those with an eating disorder or disordered eating due to the tracking nature of how this works. Coaching can be amended to be more conversational instead of tracking daily food intake or calories, which may be more appropriate for some individuals, as it could work like a journal where the healthcare professional is able to understand and support their journey using a more suitable approach.
Safe guarding is complex. If there are concerns it maybe that telehealth is not appropriate and face to
face consultations would be preferable. It is important to apply clinical judgement to each case.
It is possible that patients can inaccurately report, as they would be able to do in clinic also. Often, we
have to rely on patients to report their weight, but asking them to take a picture of their scales can help to validate this. In our experience safety issues haven’t been missed to our knowledge. As discussed in the webinar, it is possible to pick up on visual cues on a video call if something was wrong or there was a safeguarding concern.
When a digital service is offered by an external provider in an area it is usually commissioned by the local CCG. Digital/telehealth consultations set up within the NHS as part of an existing service are usually as a result of some element of service redesign which has been enabled through existing funding. Demonstrating positive outcomes is key to securing funding in the future
This can be determined by you as the clinician and can be agreed with the patient. A standard approach
would be reviewing the patient’s entries 2-3 times a week but also providing feedback once a week would still be very effective. The times aren’t necessarily set, this can be flexible, but just set out expectations before coaching begins.
It is important to ensure you have a strong internet connection if your session requires an internet
connection otherwise it will diminish the quality of the session and patient experience. Pre-recorded sessions are an alternative to group education, but interactivity is often the preferred method.
Pre-recorded videos can be useful for training other HCPs.
As discussed in the webinar, this depends on your objectives. If it is a webinar that doesn’t require much
interactivity from the group you can host large numbers. If it is an interactive group session, 10-15 patients would be an ideal number. If you do have large numbers you can create “breakout rooms” on some software platforms which can help to manage larger groups.
You should allow the same amount of time for telehealth appointments.
Either using a work phone number or a private number are both options. The issue with using a withheld
number is that some patients do not like to answer these calls.
You could either use an online coaching platform or you could ask the patient to send you the journal electronically before the call. You would need to ensure your methods were in line with your local information governance policies and steps were taken to encrypt or protect sensitive data.
This list may not be exhaustive, but examples of software that enables patient-to-clinician communication
include Nutrium and Kalix. Functionalities of each software is different so ensure you do your research to ensure the software will meet your needs. You can find several dietitian reviews of Nutrium software online. Oviva are a digitally-enabled dietetic service however, to our knowledge, this software is no longer available for external purchase. As the interest in digital health increases, it is likely that more software like this will be developed in coming years.
Coaching will depend on the functionality of your software, however how it can work is that patients track their daily food intake by using text or photos and the dietitian is able to give feedback in real time. Patients can also share their weight, activity, blood pressure, blood glucose, bowel movements etc.
This is about setting realistic expectations with the patient. A good way to manage this is to coach them more intensively at first and then relax the frequency of support, for example after 8 or 12 weeks.
Firstly, you will need to check that the software is approved by your local trust, but platforms such as
Microsoft Teams, Google Meet and Zoom are all examples of platforms where groups education can be held. There are also webinar platforms which can provide another option.
There are apps that track daily food intake and support self-monitoring, to find out more check out the
BDA app library here: https://www.bda.uk.com/practice-and-education/nutrition-and-dietetic-practice/ digital-practice/bda-app-library.html.
No, not as far as we are aware.
No, we would recommend you download the app and use it yourself to assess its suitability, and using
your clinical judgement decide if this is appropriate with the client. This would be important, whether or not you use the NHS app library or the BDA app library. Please check out our BDA app library, as all apps here have gone under independent review and you can be assured of clinical effectiveness and data security https://www.bda.uk.com/practice-and-education/nutrition-and-dietetic-practice/digital-practice/ bda-app-library.html.
If you are unable to get a reliable weight or MUST score then the Patients’ Association Nutrition Checklist
can be a useful tool for self-monitoring of malnutrition.
Some apps will allow patients to directly upload or track their blood glucose levels in real time. The other
option is for patients to take a picture or scan these to be sent securely to the clinician.
This would need to be agreed with individual GP practices, but may not be possible.
Yes, companies such as Thriva provide an easy way for patients to get blood results without needing input
of their GP.
There is very little dietetic led published research. We would love to hear the results of your work and
details of your publication. Please let Chloe Adams at the BDA know when the publication is available. Ro Huntriss has written a paper regarding weight management using digital care versus face-to-face. We hope that this will be published later this year. Please feel free to contact Ro directly if you would like a copy of this research once published.
That’s great to hear you are undertaking research, please do share your results with Chloe Adams at the
BDA.
Not as far as we are aware, but the BDA Digital Dietitians section of the website will be updated with
relevant research as and when it is published.
