Increasing Patient Return Visits Ann Silver, MS, RDN, CDE, CDN Private Practice

Disclosure Co-author of this book for the Academy of Nutrition and Dietetics © Ann Silver, MS, RDN, CDE, CDN

What will we accomplish?What will we accomplish?  At the conclusion of the presentation, attendees will be able to explain tactics they can utilize to increase follow-up appointments.  © Ann Silver, MS, RDN, CDE, CDN

Tell me about YOU © Ann Silver, MS, RDN, CDE, CDN

First question to askFirst question to ask Why? To establish the reason(s) © Ann Silver, MS, RDN, CDE, CDN

Why? From the: Patient’s Perspective and RDNs Role © Ann Silver, MS, RDN, CDE, CDN

Then…Then… what can you do to get patients to return??? © Ann Silver, MS, RDN, CDE, CDN

Know the reason*. *maybe © Ann Silver, MS, RDN, CDE, CDN

Address it!!! © Ann Silver, MS, RDN, CDE, CDN

Some reasons have solutions and some reasons have no solutions. © Ann Silver, MS, RDN, CDE, CDN

What is the cause? What can YOU do? © Ann Silver, MS, RDN, CDE, CDN

From the patient’s perspectiveFrom the patient’s perspective © Ann Silver, MS, RDN, CDE, CDN

Transportation Parking Office Access © Ann Silver, MS, RDN, CDE, CDN

Time  Too Busy  Conflicts  Commi tments © Ann Silver, MS, RDN, CDE, CDN

Unaffordable Insurance issue Unwilling to spend $ Money © Ann Silver, MS, RDN, CDE, CDN

Too much work Misconceived notions Not in “pain” © Ann Silver, MS, RDN, CDE, CDN

I know what to do. I got everything at the first appointment! © Ann Silver, MS, RDN, CDE, CDN

Pushed (or Pulled)… …by someone. © Ann Silver, MS, RDN, CDE, CDN

The chemistry is not right.The chemistry is not right. © Ann Silver, MS, RDN, CDE, CDN

Meal Planner?Meal Planner? 1 st visit © Ann Silver, MS, RDN, CDE, CDN

The RDN’s Role © Ann Silver, MS, RDN, CDE, CDN

Listening? What does the patient want? © Ann Silver, MS, RDN, CDE, CDN

Your Attitude?Your Attitude? Having a bad day? © Ann Silver, MS, RDN, CDE, CDN

Making Assumptions?Making Assumptions?  Money  Insurance  Basic information  Cooking equipment © Ann Silver, MS, RDN, CDE, CDN

Information Overload?Information Overload? © Ann Silver, MS, RDN, CDE, CDN

I am the Nutrition Expert!I am the Nutrition Expert! Therefore, I know. © Ann Silver, MS, RDN, CDE, CDN

Ethics or Practice ModelEthics or Practice Model C O N F L I C T © Ann Silver, MS, RDN, CDE, CDN

Other reasons ?Other reasons ? Sure! © Ann Silver, MS, RDN, CDE, CDN

What else you can do?What else you can do? © Ann Silver, MS, RDN, CDE, CDN

1 st visit meal plan Change your routineChange your routine X © Ann Silver, MS, RDN, CDE, CDN

Modify Your ApproachModify Your Approach Patient-Centered Interventions © Ann Silver, MS, RDN, CDE, CDN

Motivational Interviewing (MI) Cognitive Behavioral Therapy (CBT) © Ann Silver, MS, RDN, CDE, CDN

Motivational Interviewing  Assess level of motivation  Collaborative relationship  Patient is the expert © Ann Silver, MS, RDN, CDE, CDN

Objective of Motivational Interviewing  Help the patient  Explore and resolve ambivalence  Elicit behavior change © Ann Silver, MS, RDN, CDE, CDN

Motivational Interviewing Scenario Overweight 58 y male patient Dx: type 2 diabetes A1c : 7.9% “My doctor told me to come see you. I’m here, but really I don’t want to be here. I don’t want to eat differently. I have so much going on in my life I don’t have time for this.” © Ann Silver, MS, RDN, CDE, CDN

Cognitive Behavioral Therapy  Thoughts and feelings affect behavior.  Patient motivated to change.  Change the thoughts to improve the behavior. © Ann Silver, MS, RDN, CDE, CDN

Cognitive Behavioral Therapy Combines nutrition education (facts) with counseling to change behavior. © Ann Silver, MS, RDN, CDE, CDN

Cognitive Behavioral Therapy Scenario Obese 45 y female patient says: “What do you mean I can eat a chocolate chip cookie? If I eat a chocolate chip cookie, I’m not going to lose weight.” © Ann Silver, MS, RDN, CDE, CDN

Develop a relationshipDevelop a relationship © Ann Silver, MS, RDN, CDE, CDN

 Sell a package  Provide a discount © Ann Silver, MS, RDN, CDE, CDN

Questions:  What helped you the most today?  What will you be focusing on between now and the next appointment?  Where do you want to go from here? © Ann Silver, MS, RDN, CDE, CDN

End the session with: Let’s make another appointment. or When would you like your next appointment? or I’d like to see you in one week, what are your thoughts? © Ann Silver, MS, RDN, CDE, CDN

Follow-up After the appointment:   Letter  Phone call © Ann Silver, MS, RDN, CDE, CDN

To summarize:  Determine why?  Identify a solution. © Ann Silver, MS, RDN, CDE, CDN

Don’t go crazy!Don’t go crazy! © Ann Silver, MS, RDN, CDE, CDN

T This is what we WANT! © Ann Silver, MS, RDN, CDE, CDN asilverrd