ADSA News for Private Practising Dietitians

Chat 1 Comment March 30, 2017 nutritionadsa

One of the ADSA Executive Committee portfolios takes care of the needs of Private Practising Dietitians (PPDs) in South Africa. There have been some important developments in the private practice dietetics space due to the work of the ADSA PPD portfolio. Please read all of the information below if you run a private practice.

Practice cost survey

ADSA and the Hospital Dietitians Interest Group (HDIG) have been engaging with Healthman, a healthcare consultancy, to improve dietetic billing since 2016. The rates at which private practicing dietitians are remunerated have not been based on real-life practice costs. The following survey will help change this and you have a chance to be part of it!

We need as many dietitians in private practice as possible to answer the following survey. Please send this link onto non-ADSA members in private practice to help us reach as many dietitians as possible.

Important: all results are independently collated by Healthman and no dietitian will see the survey data.

Completed entries will be entered into a lucky draw for a R1000 Pick ‘n Pay voucher.

After this initial survey, we will need a minimum of forty practices to submit their financials to help assess if dietitians are fairly remunerated considering the cost of running a practice. The weekly mailer will include further information.

Please click the following link to answer the survey: Dietetics Practice Profile Survey 2017

The survey will take about 10-20 minutes to complete.

Professional Indemnity Insurance

The public are protected by the Consumer Protection Act which covers all services, including those provided by a dietitian. If a patient suffers harm or loss due to negligence, they are entitled by this act to sue the service provider – and this may include you as a dietitian.

Professional indemnity insurance is highly recommended for any private practising healthcare practitioner. ADSA has negotiated excellent rates for professional indemnity cover for dietitians. Please log onto the member section of the ADSA website and look under the PPD section (http://www.adsa.org.za/Members/PPD.aspx) to get the latest forms to apply for cover for the year.

Clarity on billing practices

Dietitians use time-based billing. As part of the consultation with Healthman last year, the descriptors were updated and sent to medical funders. Please click here: Dietitians Coding Structure 2017 to download the up-to-date billing codes. Changes to codes include re-inserting the term “planning” into the descriptors (which had been removed in 2006) and adding to the rules and modifiers. Please take the time to read through these. Previously there was confusion around whether or not a dietitian could charge for time spent planning without the patient (non-contact medical nutrition planning). This change now means that a dietitian can charge for non-contact medical nutrition therapy. This amount is capped at 50% of the total time claimed.

Update on Discovery Vitality benefits

Many dietitians have asked questions around changes in the Discovery Vitality programme. Please click here for a letter from Craig Nossel, head of the Vitality programme, explaining why the changes have been made. Letter from Craig Nossel

Some practical information with regards to the new changes:

• To claim points, Vitality members must submit their statement from the dietitian to the medical aid and points will be automatically allocated.
• If the person is not a member of the Discovery Health Medical Scheme, they can email their statement to: claimsvitalitypoints@discovery.co.za and points will reflect automatically.
• The dietitian no longer needs to enter anthropometry in the same way she/he did for the Vitality Nutrition Assessment.
• 1000 points will be awarded for seeing a dietitian per year.
• The appointment must be at least 30 minutes long.
• If a dietitian is working at a wellness day and the company covers the cost of the assessment, a zero-cost statement with the Vitality member’s information can be used to claim points.
• The Vitality Weight Loss rewards programme is yet to be launched – dietitians will be made aware of what is happening before the programme launches.

ADSA and the Discovery Vitality team regularly meet to discuss developments.

As always, if you have any questions or concerns you would like us to raise, you are welcome to contact Nathalie Mat: adsappdqueries@gmail.com.

 

Salty South Africa – are we doing better after salt legislation?

Chat 1 Comment March 20, 2017 nutritionadsa

Despite South Africa passing world-leading legislation to reduce salt intake, too many South Africans eat too much salt, putting themselves at risk of heart disease and strokes. Today is the start of  Salt Awareness Week which runs from 20-26 March.

 

Salt – a forgotten killer

Excess salt intake directly increases blood pressure in most people, and exacerbates high blood pressure in people who already have this condition. “High blood pressure is not only caused by high salt intake, and factors such as genetics, obesity, fruit and vegetable intake, stress, smoking and a lack of exercise all contribute. However, reducing salt intake is a safe, affordable and effective strategy to reduce high blood pressure or avoid developing high blood pressure” says Prof Naidoo, CEO of the Heart and Stroke Foundation South Africa (HSFSA).

The World Health Organization (WHO) reports that it’s African region has the highest prevalence of high blood pressure globally. People of African origin are more prone to salt sensitivity, and excess salt is consumed through both liberal addition of salt to meals and as salt hidden in many processed foods. In South Africa, the prevalence of high blood pressure ranges from 30% to as high as 80% in adults over the age of 50 years (1) .

A world-leader in salt reduction

South Africa is ahead of the pack with ground-breaking legislation to limit the salt content of certain foods. June 2016 marked the implementation of these regulations that have reduced salt in commonly consumed foods such as breads, breakfast cereals, and processed meats. So far legislation has been hugely successful with most manufacturers complying, and some products have reduced salt content by 30 to 40%.

What can the food industry do?

During World Salt Awareness Week, WASH and the HSFSA are calling on manufacturers to put less salt in our food, and challenge everyone to read food labels and choose the lower salt options – it’s as easy as that! Salt legislation will reduce salt intake by approximately 0.85 grams per person per day, depending on the individual’s food choices. One study estimated that this level of salt reduction will result in 7 400 fewer cardiovascular deaths and 4 300 fewer non-fatal strokes every year in South Africa (2) .

The WHO recommends that total salt intake should not exceed one teaspoon a day, an amount equal to 5 grams. The average South African eats roughly 8.5 grams of salt per day (range of 6 – 11 grams), with some people eating significantly more than this (3) . Salt legislation is a good start, but it is inadequate to curb excess salt intake.

How do we eat so much salt?

“Salt intake is not easy to measure and is hidden in almost everything we eat, even sweet foods. When adding extra salt in cooking or at the table, all the pinches, shakes and grinds of salt add more salt than we actually need. One take-out meal can triple our salt limit for one day. Even something as simple as a cheese and ham sandwich can provide 2.5 grams of salt, already half the daily limit” says Gabriel Eksteen, Dietitian and Exercise Physiologist at the foundation.

Do YOU eat too much salt?

The Heart and Stroke Foundation SA launched an online salt calculator in 2015 in partnership with Unilever South Africa. This is the easiest way to see how much salt you eat, and which are the main salty culprits in your diet. The calculator has been carefully updated to improve accuracy and to reflect changes after salt legislation. Test your salt intake at www.saltcalculator.co.za . You may be surprised where your salt comes from!

How to reduce salt intake

Total salt intake includes what is already in the food, and what people add to food while preparing or eating the food. Choose foods wisely, keeping an eye out for food products with the Heart Mark logo and eat salty foods less often. How much salt is added at home is completely in the individual’s hands. When using salty ingredients like stock cubes, soy sauce or chicken spice as part of cooking, don’t add any further salt. Taste food while cooking and at the table, and think twice before adding more salt!

Get tested

One in every two South Africans with high blood pressure remain unaware of their condition. This prevents effective care and increases the risk of heart diseases and strokes. The HSFSA recommends that all adults test their blood pressure at least once every year. The public can get their blood pressure measured for free from 17 March until 9 April at all Dis-Chem pharmacies nationwide.

The next step forward

South African salt legislation will further reduce the salt levels of certain foods by 2019. Yet many foods are excluded from legislation, including fast foods. The HSFSA call on the fast food industry to clearly display the salt content of their meals, and to start reducing the salt content of their offerings. Graham MacGregor, Professor of Cardiovascular Medicine at The Wolfson Institute of Preventive Medicine and Chairman of WASH comments: “Salt damages our health. Salt reduction is the simplest and most cost effective measure to prevent thousands of unnecessary deaths from stroke and heart attacks every year. It is not just down to the individuals; manufactures must stop adding salt to our foods. During World Salt Awareness Week you can do something great for your health by eating less salt“.

 

1) Lloyd-Sherlock P, et al. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control.
Int J Epidemiol. 2014 Feb;43(1):116-28. doi: 10.1093/ije/dyt215

2) Bertram et al. Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa. S Afr Med J
2012;102(9):743-745. DOI:10.7196/SAMJ.5832

3) Wentzel-Viljoen et al. “Use salt and foods high in salt sparingly”: a food-based dietary guideline for South Africa. South African Journal of Clinical Nutrition 2013; 26(3): S105-S113

Meet registered dietitian, Thembekile Dlamini

Chat 1 Comment March 13, 2017 nutritionadsa

We chat to registered dietitian and ADSA spokesperson, Thembekile Dlamini to find out why she became a dietitian and what she loves most about her work. Thembekile works at the Free State Department of Health, is busy doing her PhD in Public Health and has a special interest in paediatric nutrition.

Why did you become a Registered Dietitian?

Saving lives has always been my first priority but I didn’t want to do it in the usual and obvious ways that society dictates. I saw a need to communicate the science of nutrition especially for the benefit of the black community. I thought if I understood healthy eating in any context, I would then be able to disseminate information correctly and with sensitivity to cultural preferences. That way I knew I would make a difference and save lives through nutrition.

What do you enjoy most about the work you do? What are the most satisfying moments?

I am mostly based in the paediatric ward, doing both inpatients and outpatients. When I meet a helpless soul in the ward admitted for whatever condition, just knowing that I will make a difference in their life makes my life and work enjoyable.

Most satisfying moments: every time my little patients get well and are discharged and I know I made a huge difference on their journey to getting better.

What has been your career highlight?

I have a couple of those:

• When mortality rates of a hospital dropped within 3 months of my arrival in the facility.
• When my child health and nutrition research paper got an award for best poster presentation in 2015 in the whole province.
• Getting a Gold award for saving cost of service delivery in the province through my hard work.

What are the most challenging aspects of your career?

Working with the most disadvantaged communities which cannot afford even the basic foods. Counseling them becomes a challenge because they always highlight their affordability challenges.

How do you cope after a day of nutrition disaster and bad eating choices?

I have a few of those but when they happen, I drink lots of water and morning exercise.

What are the three things that you think people should stop saying when they meet a dietitian?

• Please give me a diet
• I want to loose weight
• Give me a list of the right foods to eat

What should clients look out for when deciding which dietitian to work with?

• Dietitian must be registered with the Health Professions Council of South Africa
• Dietitian must have a practice number and/or have a facility practice number
• Must be easily accessible
• Must be reliable
• Must have a love for people
• Must provide quality services

What is your favourite dish and your favourite treat food?

Pap and Masonja (Mopani worms) in tomato sauce!

I love Rum ‘n Raisin ice cream. A bowl of that is the perfect treat!