Specialist Adult Dietetic Service
1st May 2016
The following criteria is for the service commissioned for patients registered with a GP in the following CCG areas – Stafford and Surrounds, Cannock Chase, South East Staffordshire and Seisdon.
Eligibility Criteria
- Aged 18 years or over;
- Medically unstable individuals whereby dietary factors are a contribution to an exacerbation of their condition:-
- Type 1 diabetes where dietetic service is not provided through alternative specialist services
- On a texture modified diet or thickened fluids
- BMI below 18 with clinical/dietary concern
- MUST 3 and above
- MUST score >2 and completed 6 Steps to Appropriate Nutritional Care in Adults with no improvement
- Patients requiring enteral feeding
- Irritable Bowel Syndrome – Symptomatic
- Inflammatory Bowel Disease - Symptomatic
- Diverticular disease – symptomatic
- On anti-obesity medication being considered for surgery BMI>50
- Need for specialist dietary interventions for weight loss such as low calorie and very low calorie diets
- Patient’s from high risk groups as indicated in this list stepped up from Lifestyle service
- Allergy/intolerance/Coeliac Disease/Dermatitis Herpetiformis where dietetic input is needed
- Type 2 Diabetes - treated with insulin or oral hypoglycaemic agents
- Heart Failure moderate to severe New York Functional classification 3 and 4
- Patients with mental health conditions/learning disabilities requiring specialist dietetic input for weight loss on the following medication: -
- Sodium Valporate
- Lithium
- Clozapine
- Olanzapine
- Risprasidone
- Ziprasidone
- Prednisolone
- Nortriptyline
- Doxepine
- Amitriptyline
- Gabapentin
- Pregabalin
- Mirtazapine
The Service shall manage and support pre-bariatric individuals in a multidisciplinary approach to ensure all non-surgical attempts to manage weight management have been exhausted; Service Users who attend the Service as part of the bariatric surgical pathway, the Service shall offer a programme of care and support in line with NHS England policy (a minimum programme of twelve months for those who have a BMI >40kg m² and six months supported for those who have >50kg m²). A full assessment will be made of every individual prior to being referred for bariatric surgery. The importance of behaviour change will be a key outcome of the service intervention.
Step up to Specialist Dietetic Service considered after 3 months in Lifestyle Service when client has not achieved targeted weight loss (5%):
- Clients referred for bariatric surgery or previously had bariatric surgery
- Chronic Kidney Disease 3b
- Cushing's syndrome
- Lymphodema / Lipoedema
- Women with poly cystic ovary syndrome
- History of disordered eating – not currently under specialist care
- Patients fully engaged in the Lifestyle Service who have failed to lose weight at 3-6 months at GP’s discretion/need for endocrinalogical review.
All patients will be stepped down from the specialist dietetic service to community based services at the earliest opportunity.
Exclusion Criteria:
- Under the age of 18 years;
- Requiring specialised commissioned services. i.e. eating disorders;
- Individuals receiving renal replacement therapy and Chronic Kidney Disease stage 4-5
- Support to inpatients services
- Patients who can be seen in the Lifestyle Service
- Patients being seen in other specialist services with dietetic intervention
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