在宅患者訪問栄養食事指導に関する現状と課題：450名の栄養士および管理栄養士を対象としたインターネット調査による在宅訪問栄養食事指導に対する意識調査

抄録

　This internet-based attitude survey was conducted to describe the current status and challenging issues facing at visiting home nutritional guidance (VHNG) by 228 dieticians (D) and 222 managerial dieticians (MD) .

(1) There are differences in the age and career history in the female Ds and the MDs, but there was no great difference as to their residential distribution, gender, number of objects, the addresses and work environment.

(2) Ds worked mainly at meal centers, kindergartens/day-care centers, as school nutritional teachers and staff members. MDs worked mainly in hospital/nursing welfare facilities as nutritionists and catering managers. They worked in the area where their professional characteristics were best utilized.

(3) 80% of both Ds and MDs were inexperienced as VHNG counselor for home-bound patients. Many organizations have not implemented VHNG system due to lack of policies and adequate environment.

(4) Of experienced VHNG counselors for home-bound patients, 70% worked with total number of 1-10 patients as a group, about twice a month for maximum of 8-9 months/patient. The guidance contents provided groups were mainly "dietary intake and patient's health check", contents of guidance offered by Ds included "cooking instruction and shopping guidance" and "guidance of helper while those offered by MDs included" guidance on dietary content and form in various situations, "preparation of meal plans". Qualitative differences in instruction content were observed between Ds and MDs. Both groups reported that >50% of their patients responded with "the great interest to cooking" and "the nutritional position improved" after dietic guidance was given.

(5) Approximately 50% of Ds/MDs reported as reasons for low rate of implementation of VHNG; "low awareness of patients, doctors and health care workers", "cost performance" and "environmental improvement".,

　Results suggested that the need for establishing specific roles of Ds/MDs as human resources for nutrition care and development for their such as referral route based on mutual understanding among users and the medical multi-disciplinary collaborators on VHNG.