scholarly journals Detection and Management of Malnutrition in Primary Care

2021 ◽  
pp. 1-2
Author(s):  
Trude Backer Mortensen
Keyword(s):  
Primary Care ◽  
Quality Care ◽  
Community Setting ◽  
Developed Countries ◽  
Overweight And Obesity ◽  
Community Dwelling ◽  
Dietary Advice ◽  
Structured Interviews ◽  
Care Community ◽  
Oral Nutritional Supplements

<b>Background &amp; aims:</b> Malnutrition or undernutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals in developed countries. Once identified, malnutrition can be effectively treated in the majority of cases with dietary advice and the prescription of oral nutritional supplements (ONS) for patients who can eat and drink orally. However, previous research has reported inadequate screening and treatment of malnutrition in the community. The aim of this qualitative study was to explore general practitioners’ (GPs) experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. <b>Methods:</b> Sixteen semi-structured interviews including chart stimulated recalls (CSR) were conducted with GPs. The interviews and CSRs explored, among others, the following domains; barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed following a generic qualitative approach with inductive thematic analysis using NVIVO 12 to facilitate data management. <b>Results:</b> Three main themes were identified. Theme 1: ‘Malnutrition is a secondary concern’, encapsulating the idea that the identification of malnutrition is usually secondary to other clinical issues or disease rather than an independent clinical outcome. This theme also includes the idea that obesity is viewed as a dominant nutritional issue for GPs. Theme 2: ‘Responsibility for malnutrition and ONS management in the community’, highlighting that GPs feel they do not know who is responsible for the management of malnutrition in the community setting and expressed their need for more support from other healthcare professionals (HCPs) to effectively monitor and treat malnutrition. Theme 3: ‘Reluctance to prescribe ONS’, emerging from the GPs reported lack of knowledge to prescribe the appropriate ONS, their concern that ONS will replace the patient’s meals and the costs associated with the prescription of ONS. <b>Conclusions:</b> GPs in Ireland do not routinely screen for malnutrition in their clinics as they feel unsupported in treating and managing malnutrition in the community due to limited or no dietetic service availability and time constraints. GPs also view malnutrition as a secondary concern to disease management and prioritise referral to dietetic services for patients with overweight and obesity. GPs reported that they have insufficient knowledge to change or discontinue ONS prescriptions. This study demonstrates that there is a clear need for primary care training in malnutrition identification, treatment and management and more community dietetic services are needed in order to support GPs and deliver high quality care to patients.

scholarly journals A preliminary qualitative study of general practitioners’ views on malnutrition management and oral nutritional supplementation prescription in the community

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Patricia Domínguez Castro ◽  
Sharon Kennelly ◽  
Barbara Clyne ◽  
Gerard Bury ◽  
Catriona Bradley ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Qualitative Study ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Inappropriate Prescribing ◽  
Community Setting ◽  
Community Dwelling ◽  
Care Community ◽  
Oral Nutritional Supplements

AbstractMalnutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. However, previous research indicates that inappropriate prescribing of ONS occurs frequently in the community setting (30–70% prevalence). Moreover, it has been previously shown that the management of patients ‘at risk’ of malnutrition in the primary care/community setting in Ireland is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals (HCPs). In Ireland, general practitioners (GPs) are the main prescribers of ONS in primary care. They are also on many occasions the first point of contact for individuals in the community who are malnourished or at risk of malnutrition. Therefore, exploring their experiences and perceptions can provide insight into the complexities of managing malnutrition and ONS prescribing in the community. The aim of this qualitative study was to explore GPs’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Semi-structured interviews were conducted with nine GPs. The interview explored among others the following domains; Barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed using inductive thematic analysis. Three main themes were identified; i) Malnutrition a secondary concern, encapsulating the idea that malnutrition is not something that GPs screen for in isolation ii) Resources and support for managing malnutrition are needed in the community iii) Reluctance to prescribe ONS. GPs reported not screening for malnutrition, but viewed it as a consequence of other conditions and social factors. According to the GPs, they should not have sole responsibility for malnutrition management and more dietitians and trained community nurses would be desirable to support them to deal with malnutrition in the community. A preference to avoid supplementation and implement dietary changes first was expressed by GPs. As main prescribers, GPs thought that they should receive further independent trainingon the different ONS available in the market as currently they did not feel confident prescribing a range of them. Awareness of ONS cost and its misuse by certain patients were reported as reasons that made GPs reluctant to prescribe them, potentially leading to under prescribing.

scholarly journals A preliminary qualitative study of nurses’ and dietitians’ views on malnutrition management and oral nutritional supplementation prescription in the community

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Patricia Domínguez Castro ◽  
Sharon Kennelly ◽  
Celine Murrin ◽  
Catriona Bradley ◽  
Barbara Clyne ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Qualitative Study ◽  
Focus Groups ◽  
Community Setting ◽  
Nutritional Supplements ◽  
First Line ◽  
Care Community ◽  
Oral Nutritional Supplements ◽  
Patients At Risk

AbstractProtein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.

What role for oral nutritional supplements in primary care?

2018 ◽  
Vol 56 (8) ◽  
pp. 90-93 ◽  
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Nutritional Supplements ◽  
Nutritional Intake ◽  
Nutrition Support ◽  
Dietary Advice ◽  
Treatment Goals ◽  
Fortified Food ◽  
Oral Nutritional Supplements ◽  
Regular Review

Malnutrition, a deficiency of energy, protein and other nutrients, is a cause of health problems and adverse clinical outcomes.1,2 It has been estimated that a significant number of people have, or are at risk of, malnutrition and the National Institute for Heaxlth and Care Excellence (NICE) has recognised the need to improve healthcare professionals’ knowledge of the causes, effects and treatment of malnutrition.3,4 However, NICE acknowledged that “there is no clear evidence available as to whether screening is really beneficial or how it should be carried out”.4 One of the key elements to improve or maintain nutritional intake for people with malnutrition is the provision of nutrition support, including dietary advice, the use of fortified food and additional snacks. Although for some people oral nutritional supplements (ONS) may be needed, their use can be limited by poor compliance due to low palatability or unwanted effects such as nausea and diarrhoea.5 Without appropriate assessment, treatment goals and regular review processes, the provision of ONS products may be ineffective and waste NHS resources. Here, we discuss the place of nutritional supplements in the management of malnutrition.

scholarly journals Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034023 ◽  
Author(s):  
Calum T McHale ◽  
Anita H Laidlaw ◽  
Joanne E Cecil
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Weight Management ◽  
Primary Care Patient ◽  
Overweight And Obesity ◽  
Shared Responsibility ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Related Factors ◽  
Cross Sectional

ObjectiveTo understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland.SettingSeven National Health Service (NHS) Scotland primary care centres.ParticipantsA total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated.Design and methodologyA cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives.Results(1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors.ConclusionsIncongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

Building links between town and gown: an innovative organisation in south-eastern Melbourne

2016 ◽  
Vol 22 (2) ◽  
pp. 71
Author(s):  
Jenny Advocat ◽  
Grant Russell ◽  
Mary Mathews
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Research Unit ◽  
Structured Interviews ◽  
Primary Care Research ◽  
Care Community ◽  
Care Research ◽  
South Eastern ◽  
Primary Health ◽  
The Impact

Primary care is the foundation of a nation’s health care system. Real world research is a requirement of a health system built to deliver the benefits of a strong primary care community. In the last decade, new approaches to optimising the impact of research on practice and policy have been formulated across disciplines. However, in Australia, the primary care research community remains small and primary care researchers are not well represented in either receiving support for or governing research. While practice-based research networks (PBRNs) have brought GPs and, sometimes, other clinicians together with academics, few have managed to bring local decision makers and other primary health care stakeholders into partnerships where they can work together on common problems. This paper outlines a novel three-way partnership between a health authority, a primary care organisation and a university in the south-eastern suburbs of Melbourne. A case study was undertaken based on author experience of the Southern Academic Primary Care Research Unit (SAPCRU) and semi-structured interviews with representatives from partner organisations. Interviews elicited perceived barriers and facilitators, including complex financial, human resources and governance challenges, associated with bridging the gap between research and practice. It was found that SAPCRU has been successful in engaging with research partners and has begun to develop links with policy makers and orient research themes to the needs of its varied communities. Especially with the introduction of Primary Health Networks (PHNs), the model has the potential to translate to different settings but barriers should be noted.

scholarly journals Responses and Interventions to Delusions Experienced by Community-Dwelling Older Persons With Dementia

2021 ◽  
pp. 089198872110429
Author(s):  
Jiska Cohen-Mansfield ◽  
Hava Golander
Keyword(s):  
Family Caregivers ◽  
Relative Frequency ◽  
Older Persons ◽  
Community Setting ◽  
Community Dwelling ◽  
Structured Interviews ◽  
Guidance Programs ◽  
The Impact ◽  
Qualitative Analyses

We examined how family caregivers react, and what interventions they use in response to delusions exhibited by relatives with dementia in a community setting. Structured interviews were conducted with 68 family caregivers whose relatives were described as experiencing delusions based on the BEHAVE-AD or the NPI. Quantitatively, we cross-tabulated the type of response to delusion by the type of person providing the response and by the type of delusion manifested. Qualitatively, we analyzed open-ended responses to understand the types of caregivers’ responses to delusions, the contextual circumstances, and the impact of the responses. Caregiver responses to delusions included “Explaining that the delusion was wrong” (34% of responses), “Trying to calm down” (27%), “Agreeing with the delusion” (13%), “Distracting” (12%), and “Ignoring” (10%). Responses including “Anger, yelling or scolding,” were rare. The vast majority of reactions were by family caregivers of the persons with dementia. The relative frequency of the type of reaction tended to be consistent across delusion types. The qualitative analyses added some categories of reactions, but mostly highlighted issues to be considered when examining responses and their efficacy, including the use of multiple responses, and the manner and mood in which responses are conveyed. To cope with delusions, family caregivers develop intuitive intervention techniques. Understanding those interventions and reactions by caregivers and their relative efficacy can inform guidance programs for family caregivers. Improved support for family caregivers has the potential to positively influence the behavior of caregivers and older adults with dementia and improve their respective quality of life.

scholarly journals Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use—A Randomised Trial in Older Malnourished People in Primary Care

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 517 ◽  
Author(s):  
Trevor R. Smith ◽  
Abbie L. Cawood ◽  
Emily R. Walters ◽  
Natasha Guildford ◽  
Rebecca J. Stratton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Randomised Trial ◽  
Daily Intake ◽  
Nutritional Supplements ◽  
Health Care Use ◽  
Dietary Advice ◽  
Healthcare Use ◽  
Oral Nutritional Supplements ◽  
To Receive

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

scholarly journals Clinical audit in the Pediatric primary care office and overweight prevention in toddlers.

2020 ◽  
Author(s):  
Raffaele Limauro ◽  
Patrizia Gallo ◽  
Luigi Cioffi ◽  
Angelo Antignani ◽  
Valentina Cioffi ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Care Professionals ◽  
Clinical Audit ◽  
Internal Audit ◽  
Overweight And Obesity ◽  
Dietary Advice ◽  
Entire Cohort ◽  
Audit Strategy ◽  
Set Up

Abstract Background: Clinical audit is a process by which physicians or other health care professionals perform a regular and systematic review of their clinical practice and amend it, when necessary. An internal audit allows to review the activities carried out by professionals, in order to assess the appropriateness, effectiveness, efficiency and safety of the services provided. Aim of this study was to apply the process of clinical audit to the obesity/overweight care in toddlers. After the correction of the nutritional errors that were considered potentially responsible for the excess weight gain, the effect of the changes of dietary advice s on the frequency of overweight/obesity was assessed in a cohort of children aged 24-36 months. Methods: Three Italian primary care pediatricians set up the audit strategy by recognizing the high prevalence of overweight and obesity in the entire cohort of toddlers born in 2005, 2006 and 2007 (Pre-Audit group, age 24-36 months old) under their care. By reviewing their clinical practice, they changed the protocol of weaning and feeding up to 36 months, mainly reducing protein and sugar excess. The change involved the cohorts of toddlers born in the years 2010, 2011 and 2012 (Post-Audit group). Results: Change in the approach of pediatricians to children’s diet yielded a reduction of the frequency of overweight/obesity in children between 24 and 36 months of life from 26.3% in the Pre-Audit group to 13.9% in the Post-Audit group (p<0.0001). Conclusion: Clinical audit revealed high rates of obesity/overweight among toddlers. The practice developed a new strategy for nutritional counseling, which was effective in reducing the frequency of overweight/obesity in young children. Keywords: Children; Clinical audit; Feeding; Overweight, Weaning.

scholarly journals Clinical audit in the Pediatric primary care office and overweight prevention in toddlers.

2020 ◽  
Author(s):  
Raffaele Limauro ◽  
Patrizia Gallo ◽  
Luigi Cioffi ◽  
Angelo Antignani ◽  
Valentina Cioffi ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Care Professionals ◽  
Clinical Audit ◽  
Internal Audit ◽  
Overweight And Obesity ◽  
Dietary Advice ◽  
Entire Cohort ◽  
Audit Strategy ◽  
Set Up

Abstract Background: Clinical audit is a process by which physicians or other health care professionals perform a regular and systematic review of their clinical practice and amend it, when necessary. An internal audit allows to review the activities carried out by professionals, in order to assess the appropriateness, effectiveness, efficiency and safety of the services provided. Aim of this study was to apply the process of clinical audit to the obesity/overweight care in toddlers. After the correction of the nutritional errors that were considered potentially responsible for the excess weight gain, the effect of the changes of dietary advice s on the frequency of overweight/obesity was assessed in a cohort of children aged 24-36 months. Methods: Three Italian primary care pediatricians set up the audit strategy by recognizing the high prevalence of overweight and obesity in the entire cohort of toddlers born in 2005, 2006 and 2007 (Pre-Audit group, age 24-36 months old) under their care. By reviewing their clinical practice, they changed the protocol of weaning and feeding up to 36 months, mainly reducing protein and sugar excess. The change involved the cohorts of toddlers born in the years 2010, 2011 and 2012 (Post-Audit group). Results: Change in the approach of pediatricians to children’s diet yielded a reduction of the frequency of overweight/obesity in children between 24 and 36 months of life from 26.3% in the Pre-Audit group to 13.9% in the Post-Audit group (p<0.0001). Conclusion: Clinical audit revealed high rates of obesity/overweight among toddlers. The practice developed a new strategy for nutritional counseling, which was effective in reducing the frequency of overweight/obesity in young children.

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