Since 2018, Quebec dietitians and nutritionists have been authorized to carry out new activities. However, they are struggling to put them into practice in certain establishments in the health network, which creates an inequity in the provision of care in Quebec, deplores their professional order.
For the past six years, these professionals working in the clinical nutrition sector have been allowed, under certain conditions, to remove feeding tubes, administer medications orally or enterally, by tube, as well as prescribe micronutrients (vitamins and minerals), nutritional formulas and pancreatic enzyme solutions to restore the integrity of the feeding tube. For about two years, they have also been able to prescribe laboratory tests and macronutrients (proteins, carbohydrates and lipids), as well as adjust patients’ insulin and antidiabetic medications.
However, all of these new activities are still little known to the public, managers and other health professionals, says Joëlle Emond, president of the Ordre des diététistes-nutritionnistes du Québec (ODNQ). “I am also told about a lack of support. In many places, the steps to deploy these activities are being taken by dietitians-nutritionists rather than management.”
“However, these new activities allow us to work intelligently and to complete the entire nutritional treatment without delay for the patient. It also allows us to avoid having to unnecessarily monopolize the other members of the care team who, previously, were the only ones able to carry out these actions,” emphasizes Joëlle Emond.
Expanding professional practices is a “win-win” path, she says. “This is especially true for remote areas that are struggling with a shortage of workers.”
“However, the deployment of activities is variable across the territory. Some healthcare establishments have quickly organized themselves to allow dietitians-nutritionists to carry out activities that are now authorized for them. But there are others who are slow to do so.”
Obstacles
For Roxanne Papineau, clinical nutritionist in nephrology at the Institut universitaire de cardiologie et de pneumologie de Québec, the possibility of practicing new activities has had very beneficial effects on her practice, she maintains.
“Kidney health is an area where the nutritional treatment plan is very dependent on laboratory tests, whether it’s to assess the phosphorus level, the potassium level or the bicarbonate level in the blood,” she explains. “We can also now measure sodium and protein intake in 24-hour urine collections.”
Mme Papineau is therefore pleased to have the trust of her team members. However, she has already encountered certain obstacles when prescribing laboratory tests for patients in the region, she says.
“Some prescription centers are not aware that the nutritionist can prescribe certain things. There can also be comments like: ‘She’s just a nutritionist,'” says the woman who has been practicing the profession for 19 years.
As a result, Roxanne Papineau will not necessarily receive all of the results requested, she points out. It also happens that a patient himself reports to the dietitian-nutritionist that certain prescriptions have been refused. “But we see this less and less. Prescription centres are more and more used to it,” she adds.
Joined by The Dutythe Ministry of Health and Social Services (MSSS) claims to be working with the Office of Professions, professional orders, network managers and various professionals as part of “major projects on the expansion of professional practices that are underway.”
“Interprofessional collaboration and its obstacles or issues identified in the field are part of the work. The management of establishments in the health and social services network will have to implement the solutions chosen following the work carried out by the MSSS and support professionals in the change,” maintains Francis Martel, spokesperson for the ministry.
A previous version of this text, which stated that dietitian nutritionists can prescribe micronutrients, nutritional formulas, and pancreatic enzyme solutions to aid digestion, has been corrected.