To explore how dietitian supplementary prescribing for those with CKD aligns with person-centred care

Introduction

In 2016, United Kingdom (UK) legislation changed to permit dietitians to work as supplementary prescribers. Currently, there is a lack of published empirical research on this extended role. In chronic kidney disease, this role has been implemented by dietitians to prescribe medicines alongside diet advice. As person-centred care (PCC) is a key priority in this clinical area and a core aspect of prescribing competency, studying dietitian prescribing through this lens is both relevant and contemporary. The aim of this study was to explore how dietitian prescribing for those with CKD aligns with PCC.

Study design

Informed by a scoping review, a mixed methods approach was used for this study comprising two phases. Underpinned by a theoretical framework, the person-centred practice framework (PCPF), the study design was robust and supported integration of both phases of the study. Concepts of PCC in the context of NMP were established, to be able to evaluate alignment with PCC. Phase 1 used a validated tool, the person-centred practice inventory – staff (aligned with the PCPF), within a survey to evaluate dietitian prescribers’ perceptions of strengths and weaknesses in their care provision. Phase 2 used semi-structured interviews to explore patient experiences of dietitian prescribing. Inferences were made from both phases of the study. Phase findings were integrated using a joint display to allow appraisal of aligning and non-aligning themes. Meta inferences were developed using the integrated findings and inferences from each phase.

Findings

Dietitian prescribers perceived that there were many strengths in their prescribing practice that aligned with PCC. These related mostly to their direct interactions with those with CKD: possessing the necessary professional attributes and using person-centred processes with their patients. External influences on PCC were also identified: contributing to skill mix, working well within clinical care teams and the unique role dietitian prescribers can contribute by bringing diet and medicines treatment approaches together. The impact of broader organisation factors (barriers) on the person-centredness of their practice was not clearly established. People with CKD experienced PCC when dietitians prescribed for them. This was evidenced in four themes: ‘You feel like they’ve got your back a bit’, ‘He’s just like us really’, ‘It’s pretty much a joint conversation’ and ‘It’s difficult to see a doctor’. These themes represented strong communication and relationships with the dietitian prescribers, enabling involvement in decisions about their medicines, and improved accessibility and efficiency.

Contribution to knowledge

This study represents the first study to explore dietitian prescribing in CKD. Dietitian prescribing for those with CKD aligns with PCC; dietitian prescribers have the professional attributes and ways of engaging with patients resulting in PCC experiences. These findings are significant for patients, CKD care providers, the dietetic profession and the wider non-medical prescribing community. Dietitian prescribing in CKD should be fully supported, making use of their unparalleled expertise bringing diet and medication approaches together, to improve patient care and meet universal PCC goals.