Medical Nutrition Therapy is Vital
Medical nutrition therapy should eventually become more available and more a part of your total HIV medical care.
In September, the Los Angeles County Commission on HIV Health Services (LACHHS) approved a document titled "Guidelines for Implementing HIV/AIDS Medical Nutrition Therapy Protocols." First approved in October 1997, and drafted by the commission's Standards of Care Committee, this 62-page revised document is part of an evolving collection of standards of care for those infected and at risk for HIV disease.
Medical nutrition therapy includes the following components: nutrition screening, nutrition referral, nutrition assessment, nutrition intervention, communication with the health care team, and nutrition outcomes evaluation.
The document was designed for medical practitioners, administrators, third-party payers, and people living with HIV and their families to easily understand the role of HIV medical nutrition therapy in the comprehensive medical management of HIV disease. While not legally binding, it was the vision of the committee that these documents would apply to any "public or private" entity providing HIV care within Los Angeles County.
Cultural sensitivities and linguistic differences are recognized to be extremely important and that must be served throughout all care.
Know Your Rights
Rights of clients in regard to medical nutrition therapy are spelled out in the guidelines.
First, "all HIV-infected individuals" have the right to access "early and ongoing medical nutrition therapy." Individuals "have the right to be informed that medical nutrition therapy is available to them," that it be available "at a time and location that is convenient to when and where medical services are received," and that it is provided "without excessive cost."
Secondly, clients have the right to adequate medical nutrition therapy "provided by a qualified, HIV-knowledgeable and capable registered dietitian. This dietitian should be culturally and linguistically competent, and able to communicate and educate effectively in collaboration with the clients' medical team."
Further, all HIV-infected individuals also "have the right to self-determination and the right to refuse medical nutrition therapy."
Finally, "clients have the right to receive medical nutrition therapy in an environment that safeguards and maintains their confidentiality."
When to See a Dietitian
According to the guidelines, referral to a registered dietitian is automatic for an HIV-infected adult, when any one of the following conditions exist:
Medical nutrition therapy is a medically necessary service and needs to be treated as such.
An HIV-infected adult, adolescent or child should receive appropriate medical nutrition therapy at the same location on the same visit as when medical care is received, according to the guidelines. A registered dietitian should be available on site during clinic hours for comprehensive consultations and for frequent quick follow-up visits as required.
When this happens, clients gain information, self-management skills and nutrition support, and the medical health care team gains nutrition knowledge and perspective. For the most part medical practitioners have not been adequately assessing the nutritional considerations when deliberating treatment strategies.
The document lists the following benefits of establishing the guidelines and providing medical nutrition therapy in HIV care:
One problem, the lack of reimbursement for outpatient nutrition services, may be nearing resolution. If passed, the Medicare Medical Therapy Act of 1999 (HR 1187/S 660), co-sponsored by a majority of representatives in Congress would require reimbursement for medical nutrition therapy under Medicare Part B. The hope is that if Medicare covers nutrition, other health care plans will follow. Calling or writing your legislators in support of this bill is needed and greatly encouraged.
Development of Standards
Over the last the last three and one-half years, the Standards of Care Committee has developed standards of care in the following areas: counseling and testing, mental health, treatment education and advocates, case managers, dentistry, opportunistic infection prophylaxis, medical social work and anti-retroviral treatment guidelines. An internet web site is planned to house these documents.
For copies of the individual documents or for information on the Standards of Care Committee and the Los Angeles County Commission on HIV Health Services, call Diane Walker at (213) 351-8025. For more information about providing HIV medical nutrition therapy, call Marcy Fenton, M.S., R.D. at (323) 993-1612.
Marcy Fenton, M.S., R.D., is AIDS Project Los Angeles' HIV nutrition advocate. She can be reached at firstname.lastname@example.org or by calling (323) 993-1612. For upcoming free community forums on nutrition, see the calendar of this edition of Positive Living.
This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).
This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.