JOINT BASE SAN ANTONIO, Texas –
The Joint Base San Antonio-Randolph Medical Clinic is one of the “hubs” of a program that is changing the way the Air Force provides diet and nutrition counseling to its health care beneficiaries.
Known as tele-medical nutrition therapy, or tele-MNT, the program was proposed about five years ago when Air Force health and wellness centers transitioned to health promotion offices, leading to a decrease in manning and availability of nutrition services throughout the Air Force, said Emily Newman, Air Force Tele-MNT program manager.
“As gaps were identified in the availability of registered dietitian nutritionists at various military treatment facilities, tele-MNT was proposed to help fill the gaps,” she said. “The tele-MNT program uses a hub-and-spoke model for providing nutrition care via video teleconferencing equipment.”
Dietitians are located at hub sites, providing traditional in-person counseling to patients at those sites and using VTC equipment to provide nutrition counseling to patients at spoke sites, which are locations without RDNs, Newman said.
JBSA-Randolph is one of six hub sites and will serve two spoke sites in Texas – Laughlin and Goodfellow Air Force Bases – starting next year. The other hub sites are Edwards Air Force Base, California; Joint Base Andrews, Maryland; Joint Base Anacostia-Bolling, Washington, D.C.; Joint Base Pearl Harbor-Hickam, Hawaii; and Royal Air Force Lakenheath, England.
The program includes six other spoke locations in addition to Laughlin and Goodfellow, Newman said. Four of them are actively providing patient care and the four others are in various stages of the setup process.
Newman, who serves as the RDN at JBSA-Randolph as well as the tele-MNT program manager, said the Air Force has approximately 100 dietitians – a combination of active-duty members, contractors and civilians – but about 20 bases do not have an RDN.
“This is due to the size of the population at the installation and/or the presence of a joint base in which the sister service may provide nutrition services,” she said.
Tele-MNT started out as a pilot program to determine if video teleconferencing was as effective as face-to-face nutrition counseling and a research study was initiated, with data collection concluding last month.
“Hub and spoke sites were set up based on multiple factors, including data for nutrition diagnoses in active-duty members, dependents and retirees at various bases and their surrounding areas,” Newman said. “Some of the hub and spoke sites have changed as the program has evolved based on ability to recruit qualified dietitians in rural areas as well as spoke site support of the program.”
The program manager position was added in 2017 and assigned to JBSA-Randolph “for continuity of the program and to serve the growing population nutrition needs north of San Antonio,” she said.
“The dietitian presence at Randolph over the past two years has validated the need to make it a traditional hub site,” said Newman, who previously worked as an RDN at Vance Air Force Base, Oklahoma.
Newman has started working with the Defense Health Agency’s Virtual Medical Center to manage the program’s referral and scheduling process.
“In general, spoke site patients are referred for tele-MNT by their primary care team,” she said. “The patients are then booked into the RDN’s schedule and, on the day of their appointment, show up to their clinic as they would for any medical appointment. They are directed to a secure location where they are connected to their RDN via VTC equipment.”
Initial visits typically take about an hour and follow-ups about 30 minutes, Newman said.
“The patients warm up quickly to speaking with the RDN via video teleconferencing equipment,” she said.
Not all patients are referred by their primary care team, Newman said.
“Self-referrals are welcome for the hub locations,” she said. “Spoke sites are recommended to have a referral placed as this is how the appointments are scheduled between locations. However, most providers are very willing to place nutrition referrals if requested by their patients.”
By allowing evidence-based medical nutrition therapy to be part of patients’ disease management plan, the tele-MNT program improves nutrition care, Newman said.
“The tele-MNT RDNs are able to provide care for a variety of disease states such as diabetes, heart disease and cardiovascular disease as well as digestive issues, malnutrition, prenatal care and more,” she said. “They are also able to provide nutritional counseling to active-duty members, which helps support the readiness mission.”
Tele-MNT gives the Air Force another resiliency tool.
“Tele-MNT is one modality that allows dietitians to support nutritional resilience for our active-duty and beneficiary populations, especially at smaller installations that may be more remote,” said Maj. Denise Campbell, Air Force Medical Readiness Agency Health Promotion Nutrition chief. “These services can help members achieve a healthy weight/body composition, treat or protect against the onset of diet-related disease, and be used as a part of a multi-disciplinary treatment to decrease susceptibility to stress.”
The tele-MNT program appears to be gaining traction – with patients and with bases seeking support.
“We assess effectiveness of the program in patients’ satisfaction and the demand for program expansion,” Newman said. “Additional bases are requesting to be a spoke site.”