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首页> 外文期刊>Journal of human nutrition and dietetics >Oral Nutrition Supplements: a review of patients and prescribing practices.
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Oral Nutrition Supplements: a review of patients and prescribing practices.

机译：口服营养补充剂：对患者和处方实践的回顾。

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摘要

Background: Malnutrition in the UK is an important public health problem; both physiologically and financially (Stratton, 2005). The cost of treating the consequences of malnutrition annually is pound7.3 billion, 50% of which is spent in the community setting (NICE, 2006). Oral Nutrition Supplements (ONS) are utilised to supplement a patient's nutritional intake to meet requirements. ONS is commonly prescribed by healthcare professionals in the PCT without appropriate screening, monitoring or dietary advice (Jones & Jones, 2006). A 6-month project was undertaken to nutritionally assess patients receiving ONS and the potential cost saving of reducing inappropriate prescribing practice. Methods: Inclusion criteria were all adults currently prescribed ONS in the top five ONS spending GP practices. Patients were screened for suitability by each GP practice and invited to attend an individual consultation with a registered dietitian; clinic, domiciliary or telephone consultations were offered. Exclusion criteria were those patients currently receiving dietetic or palliative care and individuals deemed unsafe to be seen. Full nutritional screening and assessment was conducted using criteria from the Malnutrition Universal Screening Tool (MUST) plus a food diary and ONS history questionnaire. Written and verbal dietary information was provided. GPs were notified of inappropriate ONS prescription. Cost analysis was conducted by the Medicines Management Team. Results: A total of 117 patients were invited to attend individual consultations; 24 attended including two domiciliary visits. None of the patients were monitored as recommended by NICE (2006) and 75% were found to be receiving ONS inappropriately. This equates to an average of 13% ONS patients across the practices; an annual saving of pound12 622. The total PCT annual ONS expenditure from September 2006 to August 2007 was pound378 281; this equates to a predicted cost saving of pound47 398. Discussion: The ONS Project provides evidence of poor prescribingpractices and the need for continued education and dietetic support. The low number of patients willing to attend clinic greatly limited the assessment process and consequently the cost saving forecast. Further investigation into patient's medical record suggests a further 20% should discontinue ONS. Limitations included the relatively short timeline; other PCT's have realised significant cost savings over a longer project period. Conclusion: This project highlights the inappropriate prescribing practices of ONS; posing a large financial burden on the PCT. In addition to this, those patients requiring ONS are not receiving the full benefit as they do not receive appropriate dietary advice nor are they sufficiently monitored. It is proposed that prescribing practices and expenditure will greatly improve with the introduction of a local prescribing pathway and malnutrition screening and monitoring tools. Funding a prescribing dietitian from the indicated cost savings is recommended in order to provide support and maintain savings. References Jones, J. & Jones, I. (2006) A review of nutrition support prescribing practices amongst health care professionals in Kensington and Chelsea PCT and Westminster PCT, published 2006. National Institute for Health and Clinical Excellence (NICE). (2006). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition' in February 2006. National Institute for Health and Clinical Excellence. Stratton, R.J. (2005) Elucidating effective ways to identify and treat malnutrition. Proc. Nutr. Soc.64, 305-311.
机译：背景：英国的营养不良是一个重要的公共卫生问题。无论是在生理上还是经济上（Stratton，2005）。每年治疗营养不良后果的费用为73亿英镑，其中50％用于社区环境（NICE，2006）。口服营养补充剂（ONS）用于补充患者的营养摄入量以满足要求。 ONS通常是由PCT的医疗保健专业人员开具的，没有适当的筛查，监测或饮食建议（Jones＆Jones，2006）。进行了一个为期6个月的项目，对接受ONS的患者进行营养评估，以及减少不当处方操作可能节省的成本。方法：纳入标准为目前在ONS消费GP惯例中排名前五的所有成年人。每次全科医生都会对患者进行筛查，并邀请他们与注册营养师一起进行个体咨询;提供了诊所，住所或电话咨询。排除标准是那些目前正在接受饮食或姑息治疗的患者以及被认为不安全的个体。使用营养不良通用筛查工具（MUST）的标准以及食品日记和ONS历史调查表进行全面营养筛查和评估。提供了书面和口头饮食信息。 GP被告知不适当的ONS处方。费用分析由药品管理团队进行。结果：共邀请117位患者参加个体咨询; 24名代表参加了此次访问，其中包括两次家庭访问。根据NICE（2006）的建议，未对任何患者进行监测，发现75％的患者接受了不适当的ONS。这相当于整个实践中平均有13％的ONS患者;从2006年9月至2007年8月，PCT年度ONS在ONS的总支出为378 281英镑;这相当于节省了47 398英镑的预期成本。讨论：ONS项目提供了不良的开处方做法以及需要继续教育和饮食支持的证据。愿意就诊的患者人数很少，极大地限制了评估过程，因此降低了成本预测。对患者病历的进一步调查表明，应再有20％的患者停用ONS。局限性包括相对较短的时间表;其他PCT在较长的项目周期内实现了可观的成本节省。结论：该项目强调了ONS不恰当的处方做法;给PCT带来了沉重的财务负担。除此之外，由于他们没有得到适当的饮食建议，也没有得到充分的监测，因此那些需要ONS的患者没有得到全部好处。建议通过引入当地的处方途径和营养不良筛查和监测工具，大大改善处方方法和支出。建议从指示的成本节省中为处方营养师提供资金，以提供支持并保持节省。参考文献Jones，J。和Jones，I。（2006年），《肯辛顿和切尔西PCT和威斯敏斯特PCT的医疗保健专业人员对营养支持处方规范的评论》，2006年出版。美国国家卫生与临床卓越研究所（NICE）。 （2006）。成人的营养支持：口服营养支持，肠管饲喂和肠胃外营养”，2006年2月。国家健康与临床卓越研究所。斯特拉顿（2005）阐明了识别和治疗营养不良的有效方法。进程营养食品Soc.64，305-311。

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