Ethical and technical aspects of Nutrition teleconsultation in COVID-19 days

BRICARELLO, Liliana Paula; POLTRONIERI, Fabiana

doi:10.1590/1678-9865202134200265

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THEMATIC SECTION: HUNGER, FOOD AND NUTRITION AND COVID-19 • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134200265 linkcopy

Ethical and technical aspects of Nutrition teleconsultation in COVID-19 days

Aspectos éticos e técnicos da teleconsulta de Nutrição em tempos da COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective The aim of the present work was to identify, summarize and review the main scientific articles, guiding documents, and legal aspects of Nutrition teleconsultation.

Methods The study consisted of a narrative review and documental analyses. The narrative review was performed between March and April, 2021, in the PubMed, Scopus and Lilacs databases. The websites of the Federal Council of Nutritionists, the Regional Councils of Nutritionists and the Brazilian Association of Food and Nutrition were browsed for the documental analysis.

Results This article presents the main aspects of Nutrition teleconsultation in Brazil and in the world, both technical (practice, request for laboratory exams, prescription of dietary supplements, service disclosure, fees, service platforms and general conditions) and ethical norms (confidentiality and data protection). Some advantages of the Nutrition teleconsultation were also compiled, such as: cost reduction, improved access to services, increased adherence, reduced geographic barriers, increased involvement of patients and their families and improved self-care; limitations included lack of access to the necessary infrastructure, feeling uncomfortable with the technology, concerns about safety or desire to be assisted in person, among others.

Conclusion It is concluded that the Nutritional teleconsultation has promising potential in the pandemic, and may be able to overcome the social isolation challenge, that could impose data collection restrictions. Future studies may elucidate, through professional experiences, nutritional teleconsultation’s advantages and limitations, thus allowing more assertive recommendations and quality adjustments to the nutritional teleconsultation.

Keywords
COVID-19; Nutritionist; Teleconsultation

Document	Subject	Website
Law No. 6,583, dated October 20, 1978	Creates the Federal and Regional Councils of Nutritionists, regulates their functioning, and sets other provisions	https://www.cfn.org.br/index.php/legislacao/leis/
Decree No. 84,444, dated January 30, 1980	Regulates Law No. 6583, dated October 20, 1978, which creates the Federal and Regional Councils of Nutritionists, regulates their operation and sets other provisions	https://www.cfn.org.br/index.php/legislacao/leis/
Law No. 8,234, dated September 17, 1991	Regulates the profession of nutritionist and determines other measures	https://www.cfn.org.br/index.php/legislacao/leis/
ASBRAN Guidebook, 2014	Systematization of Nutrition Care. Brazilian Nutrition Association	https://www.asbran.org.br/storage/arquivos/PRONUTRI-SICNUT-VD.pdf
CFN Resolution No. 594, dated December 17, 2017	Provides rules for the registration of clinical and administrative information of the patient, under the responsibility of the nutritionist, related to nutritional assistance, in the patient’s physical (paper) or electronic medical record	https://www.cfn.org.br/wp-content/uploads/resolucoes/Res_594_2017.htm
CFN Resolution No. 600, dated February 25, 2018	Provides rules for the definition of the nutritionists’ areas of activity and their attributions, indicates minimum numerical reference parameters, by area of activity, for the effectiveness of the services provided to society and determines other measures	https://www.cfn.org.br/wp-content/uploads/resolucoes/Res_600_2018.htm
CFN Resolution No. 599/18, dated February 25, 2018	Provides rules for the Nutritionist Code of Ethics and Conduct and determines other measures	http://www.crn3.org.br/uploads/repositorio/2018_10_23/01.pdf
CFN Resolution No. 646, dated March 18, 2020	It suspends until August 31, 2020 the provisions of article 36 of CFN Resolution No. 599, of February 25, 2018, which approves the Code of Ethics and Conduct for Nutritionists	https://www.cfn.org.br/wp-content/uploads/resolucoes/Res_646_2020.html
CFN Note, March 20, 2020	Good Practices for the performance of the Nutritionist and the Technician in Nutrition and Dietetics during the New Coronavirus Pandemic (COVID19)	https://www.cfn.org.br/wpcontent/uploads/2020/03/nota_coronavirus_31.pdf?fbclid=IwAR1uFr_nluNlRDQIpmlViesbma31c_gFhu0PiSUYY2BT530IP5HECv4eJ8
CRN3 Booklet, 2020	CRN3 Guidance booklet for nutritional assistance without attendance - Nutritional assistance, assessment and off-site diagnosis during the new coronavirus pandemic	http://www.crn3.org.br/uploads/BaseArquivos/2020_05_07/Cartilha-Digital_Etica20_final.pdf
CRN-4 Guide RJ/ES, 2020	Guide for the role of nutritionists and TND in the COVID-19 pandemic	http://crn4.org.br/noticia/500/CRN-4+lanca+guia+para+orientacao+profissional+durante+a+pandemia+
CFN Resolution No. 656, dated June 15, 2020	Provides rules for the dietary prescription, by the nutritionist, of food supplements and determines other measures	https://www.in.gov.br/en/web/dou/-/resolucao-n-656-de-15-de-junho-de-2020-262145306
CFN Resolution No. 660, dated August 21, 2020	It suspends until February 28, 2021 the provisions of article 36 of CFN Resolution No. 599, of February 25, 2018, which approves the Code of Ethics and Conduct for Nutritionists	https://www.cfn.org.br/wp-content/uploads/resolucoes/Res_660_2020.html
CFN Resolution No. 666, dated September 30, 2020	It defines and rules teleconsultation as a way to carry out the Nutrition Consultation through information and communication technologies (ICTs) during the Covid	https://www.in.gov.br/en/web/dou/-/resolucao-n-666-de-30-de-setembro-de-2020-280886179
CFN Resolution No. 684, dated February 11, 2021	Professionals may provide on-line nutritional assistance until the end of the pandemic declared by the World Health Organization	https://www.cfn.org.br/wp-content/uploads/resolucoes/Res_684_2021.html

Potential Advantages
	Increase in the number of consultations carried out by nutritionists; Increase in nutritionist efficiency and productivity in rural and urban areas; Better monitoring of non-communicable chronic diseases; Reduced waiting time to consult with a nutritionist; Reduced absenteeism and abandonment of nutritional treatment; Decrease in costs for the professional (room rental, employees, displacement, loss of productivity with displacement, for example) and the patient/client/user; Possibility of more clinical discussions between professionals (which sometimes are not possible due to incompatible shifts or schedules); Increased contact/bond between professional and patient/client/user; Increased involvement of the patient/client/user and their families in their treatment and improvement in self-care; Reduction in the spread of infectious diseases, such as COVID-19, for example.
Potential Limitations
	Greater care to protect the privacy and security of patient/customer/user information; Cognitive, cultural, educational, and logistical aspects may limit the patient/client/user to some types of services; Required ICTs may be unavailable; Interference in professional communication with patient/client/user, due to reduced perception of non-verbal language; Lack of professional skills with ICTs; Not evaluating some physical signs of nutritional deficiencies and not being able to carry out an anthropometric assessment; Possibility that some anthropometric self-measured data are underestimated or overestimated by the patients/clients/users Difficulty in supervising professional practice; Need for appropriate space/place to provide the service.

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[1] Note: Prepared by the authors, based on document analysis, 2021 [⁹-¹³, ¹⁷, ¹⁹, ²³, ²⁶-²⁹].