GLP-1 Access: What Clinicians Need to Know and What RDNs Want to Understand, Pt. 2
In this episode of Nutrition411, Bonnie Chambers, MSN, FNP-C, discuss the collaboration between prescribers and registered dietitians to enhance patient care in weight management, emphasizing the importance of healthy weight loss, and highlighting the role of RDNs in ensuring patients maintain proper nutrition and hydration. This episode also addresses the challenges faced by patients without dietitian coverage, and how alternatives like diabetes prevention programs and culinary medicine specialists may bridge the gap in providing necessary dietary counseling.
Transcript:
Lisa Jones, MA, RDN, LDN, FAND: All right. Well, we're back again with Bonnie Chambers talking about collaboration between prescribers and RDNs. And in our last episode, we unpack some of the external challenges around access. Now let's shift to what happens once a patient actually gets their prescription, Bonnie. How can prescribers and dieticians work together to make that journey smoother and more successful?
Bonnie Chambers, MSN, FNP-C: I think the biggest thing as far as successful weight loss is what I always am counseling my patients on is we want healthy weight loss, not starving weight loss. So we want weight loss, like one to two pounds a week, nothing more than that. If it's more than that, then the dose is probably too high or we might need to adjust. And that's another reason why it's so important to also be referring to the RDs, to have the follow-ups with them also. It's such an important part of this treatment plan to make sure that the patients are getting their protein, staying hydrated, getting their fruits and vegetables, doing strength training, things to maintain their muscle mass. And all of that, that's a multidisciplinary type of team approach that you need to do that successfully. You really do. Because I can't see a patient every two months. There's just not room on my schedule. So that way we can every two months, you're either seeing me or the dietician and it works out really well.
So unfortunately, some people don't have dietician coverage for dietary counseling. So sometimes I'll look for diabetes prevention programs to put patients into for that dietary counseling while they're receiving the GLP-1s. There's such a big risk for malnutrition and muscle mass loss and dehydration and all those things. If these medications aren't prescribed and monitored correctly. So having everyone in the team on board working together to make sure that doesn't happen is just really vital and crucial.
Jones: Yeah. And you touched on something that's really interesting. I like that's excellent collaboration. If the dietician isn't covered, what other outside of the box ideas can we have like put them in this diabetes – because that's where they're getting... There's a dietician that usually works there that can help or somebody that's a certified diabetes educator that can talk about diet. So you're utilizing a great resource. So thank you for mentioning that. I think that's really helpful.
Chambers: Yeah. Absolutely. Also, something I've been looking into now is culinary medicine. If there's a culinary medicine specialist too, that may be covered by someone's plan also. So you just got to always think upside the box and see what you can do to get the patient what they need. But having that nutritional counseling while on these medications, it's just so important.
Jones: Yes, it's really important. So let's shift gears a little bit. Talk about information that you wish more dieticians understood about the prescribing and monitoring process.
Chambers: Well, that's a very broad question. I think I'm lucky to work with some very well-versed or dieticians that are very well-versed in the GLP-1s and the prescribing and that whole process. I think we're all on the same page as far as, again, wanting healthy weight loss for our patients and making sure that that's happening. And never hesitate to reach out to a prescriber if you see a patient that is maybe not necessarily meeting your nutritional goals or you're having any concerns, because we definitely want to hear that so that we can follow up with the patient also.
So I don't know if you guys know with these insurance plans and requirements, a lot of times we need to, well, I always document the total body weight loss in starting the medications. That's something we're always looking at. And if you could include that in your most up-to-date note with when you see the patient, that would be great too. We’re looking for 5% in six months and 5 to 10% in the first 12 months. But honestly, I think you guys pretty much know. I can't think of anything, honestly, off the top of my head, really.
Jones: Yeah. Thank you for that. I mean, I think it's a specialty onto its own, but I like the fact that reach out if you have any questions, especially if you're newer dietician practicing and you just happen to start into this specialty area. Maybe you were in renal disease and now you're like, "I want to go work with weight management." So yeah.
Chambers: Right. Yeah, absolutely. That good communication between the nurse practitioner, the bariatrician, the RDs, behavioral health, all of that, it's so important. And it's been so helpful to me in my practice. I've had some of the RDs reach out with concerns, and then I'm able to follow up with the patient. Sometimes we need to adjust the medication or whatever, but can make sure that they are doing well in their weight loss journey.
Jones: Yeah. And yes, working together, it helps the patient in the end. So how about talking about systems, workflows, and communication touchpoints? How does that help make collaboration more efficient and patient-centered?
Chambers: Well, I know all of us that prescribe the weight loss medications, we could not live without our MAs or our OAs that are helping us with the prior auths. They are the most… I have the person I work with right now, her name is Alex. She's amazing. I don't know what I do without her. She goes back and forth. She calls the patient. She calls the insurance. She just really goes above and beyond. We're constantly communicating with the patient and also communicating with each other regarding any changes or ways that we can get things to go through. I think it's just really communication's really key when it comes to these medications with your team in the office. Also, communication with the patients when it comes to the dose titration and the side effects and all of that, that's the biggest, the main thing you need for success when it comes to these medications is a good communication system.
Jones: Yes. Well, it sounds like you have one, so thank you for sharing that. And thank you so much for your insight and experiences with us and for helping bridge the gap between clinical management and nutrition care. And of course, thanks to our listeners for joining another episode of Nutrition411, the podcast.
Chambers: Thank you.