New primary care model created to dispense nutrition advice

DALLAS – Aug. 22, 2023 – Expert advice on nutrition delivered to patients electronically saved physicians time, improved patient satisfaction, and was reimbursable by insurance, UT Southwestern Medical Center researchers report. The findings, published in Nutrients, showcase a new model developed at UT Southwestern to feed the growing interest among patients in learning how food can affect their health.

“Diet is the top risk factor for early death in the U.S., and the cost of diet-related diseases here is in the billions of dollars. Most patients are not getting the support they need to improve their diets in the typical clinical model,” said study leader Jaclyn Albin, M.D., Associate Professor of Internal Medicine and Pediatrics at UT Southwestern and a certified culinary medicine specialist. “We have developed a feasible, scalable, well-received, and low-resource way to bring culinary nutrition advice to patients and build culinary medicine as a reimbursable service line.”

Over the past decade, patients have increasingly sought advice on changes in diet to improve outcomes for health conditions such as high cholesterol, diabetes, arthritis, and food allergies, Dr. Albin explained. There is also a desire for information about how to eat healthfully on a budget. Physicians typically don’t have the time to answer these questions during a standard clinic visit, and most have no formal training in nutrition.

Sending these patients to a registered dietitian is important and should be utilized when available, but this process is often impractical due to accessibility of appointments and unreliable reimbursement by health insurers. In addition, Dr. Albin said, some patients’ questions don’t necessitate a full-length appointment.

Seeking a new way to get information to patients, Dr. Albin teamed up with UTSW registered dietitian Milette Siler to apply an established electronic consultation service, eConsults, to a new specialty – culinary medicine. Culinary medicine combines the expertise of physicians, registered dietitians, and chefs to help patients improve their personal nutrition and ease health problems through delicious foods. Culinary medicine takes many forms, Dr. Albin said, ranging from sharing recipes and cooking techniques during standard patient care encounters to hosting group cooking classes that can be billed as shared medical appointments.

The cornerstone of this new eConsult service is the partnership between two specialists certified in culinary medicine: Dr. Albin and Ms. Siler. The pair consulted with UTSW’s institutional billing team and administrative leaders to design a request system for eConsults through the electronic health record. When primary care physicians or other health care professionals at UTSW file a request for eConsults, the physician-registered dietitian team develops a personalized, lay language, single-page summary of the patient’s health background and goals, personalized dietary recommendations, recipe suggestions, and tips for local resources to promote nourishing food access. The requesting physician then sends the eConsult report to the patient through the health portal.

During a pilot phase from Aug. 1, 2021, to July 31, 2022, the team recruited 11 primary care physicians to use the service. Dr. Albin and Ms. Siler delivered 25 eConsults – at least one per month and as many as four in a single month.

The primary care physicians who utilized this service reported in a qualitative survey that eConsults allowed them to provide necessary nutrition information to patients with a variety of health conditions, including diabetes, fatty liver disease, irritable bowel syndrome, eczema, rosacea, physical disabilities, and severe dietary allergies. The eConsults saved them time in patient encounters, the physicians said, and the feedback they received suggested that patients appreciated the expertise. The majority of these eConsults were covered by insurance.

One patient, a woman in her 60s, needed extra calcium in her diet to manage osteopenia, a bone-weakening condition that is often a precursor to osteoporosis. The eConsult service promptly delivered suggestions for adding high calcium foods to her diet, tips on avoiding side effects from calcium supplements, and other ways to improve bone health, such as exercise, said her physician Bethany Agusala, M.D., Assistant Professor of Internal Medicine and Medical Director of the William T. and Gay F. Solomon General Internal Medicine Clinic.

“Dr. Albin and Ms. Siler were able to distill their expertise into an easy-to-read recommendation for my patient. It’s a really helpful thing,” Dr. Agusala said.

The culinary medicine eConsult service is offered for all UTSW patients through the request of their primary care or specialist physicians or advanced practice providers. The Culinary Medicine Program at UTSW also accepts appointments for in-person physician-dietitian consults at UT Southwestern Medical Center at RedBird and will soon offer group cooking classes at community kitchens.

About UT Southwestern Medical Center  
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 26 members of the National Academy of Sciences, 19 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.