P114
WHAT INFLUENCES ACHIEVEMENT OF DIETETIC OUTCOMES IN RENAL PATIENTS?
El-Sherbini, N Alderdice J, Barrett J, Flint J, Gallimore C, Gardiner C, Harman A, Perry S, Tarm L
BDA RNG Outcomes Working Group, British Dietetic Association, 148/9 Great Charles Street, Queensway,
Birmingham
Problem: In the current financial climate it is vital that renal dietitians are able to measure the effectiveness of
their interventions in order to prove their worth as part of the multi-disciplinary team (MDT). There is a strong
drive for measuring outcomes, but as yet there are no nationally validated dietetic outcome tools.
Purpose: To examine whether specific factors influence the achievement of dietetic outcomes in renal outpatients being seen by a dietitian in a sample of UK renal units.
Background: A national working group of renal dietitians was established by the British Dietetic Association
Renal Nutrition Group (BDA RNG) in 2011. The group’s main aim was to develop renal specific dietetic
outcomes models based on the BDA Outcomes Model. Following the successful development and pilot of the
first audit tool, funding was obtained from the BDA General and Educational Trust for a national audit to be
undertaken to evaluate the effectiveness of renal dietetic interventions in the UK.
Method: 23 renal units completed the nine month audit throughout the UK. They were provided with the
Outcomes Tool and models for potassium, phosphate and oral nutritional support.
Findings:Data was collected for 245 patients for potassium management, 378 for phosphate management and
152 patients for oral nutrition support. 87% of those seen for potassium management achieved their overall
outcome compared to 66% for phosphate management and 58% for oral nutrition support. Patients were more
likely to achieve their dietetic outcome if they had fewer barriers at the end of the episode of care for
potassium (p=0.0003), phosphate (p<0.0001) and oral nutrition support (p=0.0025).
The number of dietetic consultations, stage of chronic kidney disease (CKD) and dialysis modality did not
influence the achievement of outcomes in potassium and oral nutrition support but did for phosphate
management.For the phosphate model, conservatively managed patients were less likely to achieve their
dietetic outcome (p=0.018).Patients having one review after initial consultation were more likely to achieve
their overall outcome (p=0.009).
Dietetic facilitators also appeared to play a role in influencing the achievement of outcomes. If further advice
was provided to improve knowledge, patients were more likely to achieve improvements in nutritional status.
When patients were provided individualised information in a suitable format they were more likely to achieve
and maintain phosphate levels though less likely to achieve this if a problem was identified necessitating
liaison with medical/nursing staff.
For those patients who achieved their overall outcome, a significant improvement in phosphate levels was
observed in all patients except those conservatively managed (P<0.01). A statistically significant improvement
was also seen in potassium levels (P<0.01) except in peritoneal dialysis patients although a non-significant
clinical improvement from 5.6 mmol/l to 4.7 mmol/l was observed. However in patients seen for oral nutrition
support, significant improvements in weight were only seen in haemodialysis (HD) patients (P=0.01). This
may be due to the presence of barriers including inadequate dietetic staffing levels, adverse changes in the
patient’s medical condition and frequent hospital admissions, all of which significantly affected achievement
of this outcome.
Conclusion:A range of factors influenced the achievement of dietetic outcomes in all three models.
Improving understanding of these and modifying them where possible will allow us to improve dietetic
practice and effectiveness of interventions. This information may also be useful in the development of dietetic
services and in workforce planning.