3 Ways Dietitians Can Increase Follow-Up Appointments

Today, it is common practice for providers to schedule a follow-up appointment before the client has even left the office. But that doesn’t stop the no-call, no-show clients who wreck your calendar and make rescheduling a hassle. So how do you put a stop to this lack of follow through?

Explain the need for follow-ups

While this may seem obvious to most, follow-up appointments are often lost in the wealth of information provided to the client during appointments. In addition to ensuring the client knows what to expect from their next appointment, think about also creating email follow-up sequences as well. For example, practice management and electronic health records such as Kalix gives the ability to securely contact clients at any time via its ad hoc messaging functionality.

Automate your follow-up reminders

Cater to your clients by giving them information about their follow-up appointments using their preferred contact method. Text messages, emails, and phone calls are all great ways to reach out. Make sure you’re using a HIPAA secure program for your messaging to ensure confidentiality! Kalix’s automated appointment reminder functionality will remind your clients of their upcoming appointments with zero effort from you.

Make it easy for clients to reschedule

For many different reasons, people need to reschedule their appointments. By having a 24/7 calendar available online, clients can reschedule at their own convenience, at any time of the day or night. This makes scheduling uncomplicated and less time consuming for you. Kalix’s Online Scheduling feature allows you to add a widget to your practice’s website so that you can accept bookings 24/7. All bookings will sync with your Kalix appointment calendar.

There are many different ways to ensure that client follow-up with their healthcare providers. While there are many free software programs which can accomplish these tasks, they often add steps to your process and are not HIPAA Compliant. When looking for innovative solutions, be sure to seek a practice management system that will simplify your scheduling and revolutionize the way you conduct business.

Why Dietitians are Effective!

This post is by Claire Nichols, Co-founder of Kalix and Accredited Practising Dietitian. These are my personal thoughts about the article “Doubt over dietitian referrals for diabetes”. In Australia, over the last few weeks there has been much discussion about the effectiveness of Medicare-subsidised dietetic services (EPC plans) for Type 2 Diabetic patients. This came about after the publication of an article in the Australian Doctor titled “Doubt over dietitian referrals for diabetes

It’s sad dietitians need to defend their role in the management of diabetes patients. Other than IDNT online, I do some private practice work and the vast majority of my patients are Type 2 Diabetics on EPC plans. From my personal experience, these patients have complex nutrition issues with many social, environmental, behavioural and economic influences. The 1-5 appointments (2 is my average) allowed on a EPC plan, is no where near enough. Sure, there is time to provide a bit of nutrition education, set some goals then review their progress. But to equip these patients with the knowledge and skills they need to make and then maintain nutrition related behaviour change long term, many more appointments are required.

But do I think I ‘m not effective as a dietitian? No, of course not. I know I am effective! But does everyone else know this? No, maybe not. The Australian study by Ball et al (2013) examined 38 individuals’ with chronic diseases (or high risk of) preferences for receiving nutrition care. General practitioners were the preferred provider of nutrition care (n=21) not dietitians! GPs were thought to give the “most trustworthy and personalised nutrition care'” as they had “the most detailed understanding of participants’ medical conditions.” Dietitians were second (n= 12) but there was confusion about the differences between dietitians and nutritionists. Dietitians were also perceived by some be overly strict, some participants “…referred to dietitians as health professionals that ‘punish’ individuals through restrictive eating, and also use negative counselling styles.” We all know that ‘food nazi’ stereotype.

food na

Doubt over dietitian referrals for diabetes 

The author of the offending article, a medical journalist called Michael Woodhead, based his piece on a research paper by Spencer et al (2013) published in the Australian Journal of Primary Health. The paper is titled Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services” and briefly, it is a prospective observational study conducted over a 9 month period in 2011. Three private practice dietitians in Queensland were involved. The participants in the study were 129 Type 2 Diabetes referred to the dietitans on EPC plans. Mr Woodhead argues that because most of the participants failed to achieve 5% loss of body weight over an average of 2 appointments, the benefits of attending the appointments were “limited.” The other point he makes is, the non-attendance rate was high (29%), and “high rates of non-attendance have the potential to cost several hundred million dollars per year.” Yes, GPs receive money for developing EPC plans, but I am yet to receive a Medicare payment for seeing a patient after they fail to attend.


So, patients never fail to attend GP appointments? No, of course not, non-attendance is a major issue for everyone in healthcare. A systematic review found the non-attendance rate in US primary care ranged from 5 to 55% (George & Rubin 2003). An Australian randomised controlled trial comparing the different methods for following up diabetic patients, had a 65% drop out rate for GP care (the drop out rate for clinic care was 47% and 28% for shared care) (Hoskins et al 1993).


The benefits of dietetic care

I also disagree with Mr Woodhead’s first point, that the benefits of dietetic care to participants were “limited”. Five out of the 51 participants (9.8%) who returned for review appointments and had their weight remeasured (60 returned within the study period but 9 did not have their weight remeasured) lost greater than 5% of body weight. That’s a great result! Overall the average amount of weight loss between first and last appointment was 1.9 +/-2.9 kg. Participants who attended more than two consultations lost significantly more weight than those who attended two only (3.7 +/-4.2kg vs -1.1+/-1.6 kg, respectively). Unfortunately the study did not report blood glucose measures, HbA1c, blood lipids or blood pressure measurements, so it is unknown whether the participants achieved metabolic improvements. In another study, participants (Type 2 Diabetics on diabetic medication with HbA1c >7% and at least 2 co-morbidities) undergoing dietetic intervention achieved significant improvements in glycaemic control despite the amount of weight loss equalling less than 5%. The group on average lost only 2.4kg over a 6 month period, but achieved a significant reduction in HbA1c (0.5%) compared to no change in the control group (diabetic medication only) (Coppell et al 2010). So sure, Spencer et al (2013) should have recorded glucose levels, HbA1c, blood pressure etc. But you have to remember, EPC appointments are often only 20 minutes long, it’s very hard, if not impossible to review patients’ goals, answer questions, provide education and take all these measurements within the time frame. Also, accessing reliable patient data in a private setting is difficult! As a dietitian, I cannot order blood tests. Yes, I can ask the patient’s GP nicely to order tests. It does not mean I receive a copy. Any results received are often self reported by patients. The likelihood that they are reported incorrectly is high. Also I don’t know how many times I have heard “oh I’m sorry I forgot my glucose monitoring book.”

Dietitans are effective

My interpretations of the findings of Spencer et al (2013) research is- Dietitans are effective. If patients were give more appointments with us, we would be even more effective! While, Mr Woodhead’s article may be damaging short-term, the silver lining is-We are now talking about how we can do things better! We are talking about how we can include more research in private practice and how we can align research and the needs of dietitians in private practice better. That’s fantastic!


Ball, L., Desbrow, B., Leveritt, M. (2013), An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals, Australian Journal of Primary Health, [Online]

Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM and Mann J (2010), Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment- Lifestyle Over and Above Drugs in Diabetes Study (LOADD): randomised controlled trial BMJ: 341:c3337.

George A and Rubin G (2003), Non-attendance in general practice: a systematic review and its implications for access to primary health care. Family Practice; 20: 178–184.

Hoskins, P.L., Fowler, P.M., Constantino, M., Forrest, J., Yue, D.K. and Turtle, J.R. (1993), Sharing the Care of Diabetic Patients between Hospital and General Practitioners: Does it Work?. Diabetic Medicine, 10: 81–86.

Spencer L, O’Shea M-C, Ball L, Desbrow B and Leveritt M (2013), Attendance, weight, waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services, Australian Journal of Primary Health [Online].

Woodhead, Michael (2013),  Doubt over dietitian referrals for diabetes, Australian Doctor, https://www.australiandoctor.com.au/news/latest-news/doubt-over-dietitian-referrals-for-diabetes [contact-form]

The Story of Kalix

This post is by Claire Nichols, Co-founder of Kalix and Accredited Practising Dietitian.
Hi everyone. I am very excited to be sitting here writing our first ever blog post. Well, I actually have to admit, coming up with a topic for the blog was a bit daunting. I mean there are lots of things to write about really, our new features, for example, but what I really wanted to do was to start with something a bit different compared to our newsletter. I so thought I would try to answer some of the big questions; who are we, what are we doing, how we got here and the meaning of life (well maybe not that one). So here goes…

Two years ago I would have never guessed, I would be a co-founder of a software company. My knowledge of IT was little to none. Sure, I could turn on a computer, make a Word document, google a topic, but I didn’t know where, to begin with making a blog, let alone a website. Then came a problem, followed by an idea and then an opportunity.

The problem arose just after starting my previous job as Early Intervention Service Dietitian in North West Tasmania. The position was funded with a special government grant, so there was a lot of pressure to measure and evaluate the effectiveness of my professional practice. Evaluating the effectiveness of dietetic practice, is easy enough, isn’t it? When you see a patient, you measure their weight and the next time you see them, you measure it again. If they’ve lost weight you’ve done a good job if they haven’t, you then haven’t…Hopefully, you are all screaming NO right now.

For the non-Dietitians reading this;

1) Dietitians do not only see patients for weight control.

2) Weight loss is hard! Improving overall diet quality, and improved patient health is what we want to achieve as healthcare professionals, right? But how does one measure healthy lifestyle?more active and establishing a healthy lifestyle are all positive achievements. They all result in improved health, irrespective of the amount of weight loss.

 The idea So I went about investigating how to measure and evaluate professional practice. I came across International Dietetics and Nutrition Terminology (IDNT) and the Nutrition Care Process (NCP). Well, actually I was using IDNT at the time and I had been since 2009 but only to write PES statements. There is a lot more to IDNT than PES statements.

For non-Dietitians NCP is a problem-solving method that Dietitians use to “think critically and make decisions that address practice-related problems”. IDNT is a “standardized set of terms used to describe the results of each step of the NCP model.” PES is a statement about the Nutrition Diagnosis or nutrition issue. Clear? If not that’s ok, I will talk about it more in future posts.

Why I like IDNT

  • There are lots of terms, getting to close to 1000 now I think (yes I actually like that).
  • They cover all the stages of the Nutrition Care Process (Assessment, Diagnosis, Intervention and Monitoring/Evaluation) i.e. initial and review assessments.
  • They include most factors in dietetics e.g. Food variety is a term, as well as Meal or snack pattern, Nutrition quality of life responses, Frequency, Consistency, Duration, and Intensity of physical activity and of course, good old Food intake, to name a few.

ideaSo my light bulb moment….because IDNT is standardized and covers all the data a dietitian would collect during initial and review assessments if I was to write all my patient documentation using IDNT then I could use a software system to track changes in the variables associated with IDNT terms. Tracking the changes in these variables would be an easy, sensitive and efficient way of evaluating professional practice. I could even use IDNT to evaluate the effectiveness of particular interventions by correlating Intervention terms with changes in the variables associated with Assessment and Monitoring/Evaluation terms.

By using IDNT I could evaluate my professional practice without having to spend extra time measuring, recording and analyzing data. The statistical analysis would be built into patient documentation and patient documentation is something I had to do anyway!

The problem was finding a software system that uses IDNT in this way. I needed a software system that supports quick electronic documentation using IDNT terms, tracks of changes in patient data over time and correlate changes in variables.

There must be something like that out there, right? No, not really. Why? My best guess is because 1) software developers are really really expensive to hire, and 2) actual building software with this functionality would take a long time.

 The opportunity- I was very lucky to have my own software developer on hand, Felix Jorkowski. So we embarked on this little project together and it has grown and grown.

So I might be the most unlikely co-founder of a software company but win or lose I am glad I took the risk to try something new. I will finish this blog with a quote which I think sums things up really well.

“You can’t make footprints in the sands of time by sitting on your butt. And who wants to leave buttprints in the sands of time?” Bob Moawad


Nutrition Care Process and Model Part I. The 2008 Update. J Am Diet Assoc. 2008; 108:1113-1117.

Nutrition Care Process Part II: Using the International Dietetics and Nutrition Terminology to Document the Nutrition Care Process J Am Diet Assoc. 2008; 108:1287-1293.