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DIETETIC SERVICES DURING COVID-19

On March 24, Nova Scotia’s Chief Medical Officer of Health, Dr. Strang, issued an Order under Section 32 of the Health Protection Act (2004, c. 4, s. 1). It is the responsibility of all dietitians to be aware of and understand the order and how it impacts delivery of dietetic services in Nova Scotia, as well as any other civic responsibilities contained in the order.

As per the Order, Section 20a - Effective March 23, 2020 dietitians in private practice may provide in-person emergency or urgent care services and may provide virtual care for nonemergency/elective care within their scope of practice.

What is Virtual Care?

Virtual care is any care provided remotely. This includes video conferencing, internet and telephone as an alternative to face to face interventions.   If you are providing virtual care, adhere to the Virtual Practice Policy.  This policy pertains to virtual practice within NS and across provincial borders.

What does emergency/urgent care services mean?

Emergency care services require immediate attention and are unlikely to apply to dietitians in private practice. Urgent care services are where the risk of not receiving care at this time outweighs the risk of transmission of the virus. Urgent is also often used if the care service is required within 24 hours to avoid worsening outcomes or long-term negative outcomes. 

If, in your professional assessment and judgement, in-person care needs to be provided, then following all needed precautions including spacing out appointments to minimize density of people in the clinic is important. The determination of urgency will be unique to each patient and to each organization/clinic/individual provider based on what can be accommodated within the recommended precautions from Public Health authorities.

The well-being of patients and staff must continue to guide the clinical decisions made by dietitians in each of their practice settings.

What are the latest infection control procedures?

The procedures were updated as of March 24, 2020 to reflect changes to pre-screening questions related to travel, now including any travel outside of Nova Scotia. Refer back to this page regularly for further updates.

Dietitians must follow the guidelines issued by their workplace establishment and those mandated by government and by legislation including orders by the CMO.

All dietitians are required to stay up to date on the current evidence and recommendations for meeting the requirements laid out by the Chief Medical Officer of Nova Scotia. This means that all dietitians are required to regularly update their understanding of the virus based on the most up to date, authoritative, and evidence-based sources. Due to the plethora of misinformation being propagated through various media there are three sources that meet this criteria; World Health Organization, Public Health Canada and Nova Scotia Public Health. Also, the Nova Scotia Health Authority and IWK have produced excellent resources based on these resources.

Dietitians must be aware of the current protocols for office-based care (pre-screening, enhanced cleaning protocols, universal precautions and enhanced hand hygiene, etc.). Refer to the latest Bulletin from the Chief Medical Officer for current protocols.

How does a dietitian deliver virtual care?

When providing virtual care, you must first ensure that it is appropriate and does not expose the client to greater risk than other possible service delivery methods. If you are crossing provincial borders you need to check with the other jurisdiction for their processes associated with this.

As per the Virtual Practice Policy:

  • consider and mitigate the risks to the privacy of the patient’s health information 
  • comply with the expectations defined in the Standards of Practice and Code of Ethics.
  • ensure that interventions, referrals, or consultations delivered using virtual care technologies are held to the same standards and expectations as those delivered in person.
  • use their professional judgment to determine if virtual care is appropriate

Does insurance cover virtual care for dietetic services?

The decision to reimburse a dietitian’s services offered virtually lies with the private insurer, and the insurance contract held by the policy holder. You should suggest that your patient contact their insurer to verify that the insurer accepts invoices for virtual care services and take note of the requirements in this regard.  You should also check with your own insurance provider to determine if virtual practice is covered by your policy.