A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care

Cadogan, Cathal; Dharamshi, Rachel; Fitzgerald, Seán; Corish, Clare; Castro, Patricia Domínguez; Ryan, Cristí­n

doi:10.1016/j.clnu.2019.03.003

Cited by 16 publications

(20 citation statements)

References 37 publications

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“…One key issue raised that seems to be exacerbated by poor communication and referral channels was inappropriate prescribing and monitoring of ONS. The cost of inappropriate ONS prescribing has been raised in many jurisdictions and leads to both economic wastage and poor patient outcomes [21,24,41]. In response, some health systems (e.g., Sweden and the UK) have moved forward with a formal role for dietitian prescribing within their own scope of practice [42,43].…”

Section: Oral Nutritional Supplementsmentioning

confidence: 99%

“…In response, some health systems (e.g., Sweden and the UK) have moved forward with a formal role for dietitian prescribing within their own scope of practice [42,43]. There is evidence to support such practices as dietitian involvement in management can improve ONS compliance, reduce hospital readmission in older patients, reduce malnutrition-associated healthcare costs and reduce ONS cost inefficiencies [13,21,42,44,45].…”

Section: Oral Nutritional Supplementsmentioning

confidence: 99%

“…Oral nutritional supplements (ONS) are commonly prescribed in clinical practice to treat malnutrition [20]. ONS usage can be most effective for treating malnutrition when combined with nutritional advice and regular monitoring of the patient and ONS usage [21,22]. However, in practice, patients may initiate ONS therapy with little guidance on how it should be taken, or why it is justified [16,23,24].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Browne

Kelly

Geraghty

et al. 2021

Clinical Nutrition ESPEN

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Background & aim: Protein-energy malnutrition is under-recognised in the community despite being common in older adults due to physiological and social changes which are often compounded by chronic disease. This qualitative study aimed to explore the opinions of healthcare professionals (HCPs) working in the primary care and community settings about the management of malnutrition and the prescription of oral nutritional supplements (ONS), often included in the treatment of malnutrition. Methods: Twelve healthcare professional (HCP) focus groups with 75 participants were conducted: community dietitians (n ¼ 17), registered dietitians working in industry (n ¼ 5), community and residential care nurses (n ¼ 22), physiotherapists (n ¼ 12), pharmacists (n ¼ 9), occupational therapists (n ¼ 6) and speech and language therapists (n ¼ 4). Focus group discussions were audio-recorded and transcribed verbatim. The data were coded and analysed using thematic analysis and key themes with illustrative quotes extracted are presented. Results: Similar views on malnutrition management existed across professions. 'Gaps in Primary Care Management' was the first key theme wherein HCPs identified limitations in malnutrition management in the community. Barriers included limited or no dietetic services available in primary care and poor communication between general practitioners and wider primary care team members which resulted in inappropriate or delayed treatment. The second key theme, 'Challenges with ONS use in the Community', encapsulated several issues HCPs experienced with ONS usage including inappropriate prescribing and lack of monitoring of treatment goals. Conflicts of interest regarding dietitians working in industry assessing and treating older adults in residential care settings was highlighted by participants. Conclusions: This study highlights that more emphasis is needed to identify patients when they are at risk of malnutrition to avoid advanced or severe malnutrition presentations currently seen. Community

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Section: Oral Nutritional Supplementsmentioning

confidence: 99%

Section: Oral Nutritional Supplementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Browne

Kelly

Geraghty

et al. 2021

Clinical Nutrition ESPEN

Self Cite

View full text Add to dashboard Cite

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“…Because dietetic professionals are suggested as a solution to the challenge of prescribing ONS 12 and as the best in making the choice of which supplement to use, 14 this Swedish setting is suitable for gaining more knowledge on dietitians’ experiences from performing this task. Even though there are recommendations on how to deliver an appropriate ONS prescription (e.g., set desirable goals, tailor it individually, advice on food first strategies and monitor continuously), 9,10 researchers scarcely report on important details of ONS interventions, thus making it difficult to replicate successful trials 18 . Insights into important features of the dietetic professional practice of prescribing ONS would be valuable for characterising key aspects of a successful ONS prescription.…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of dietitians’ experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support

Liljeberg

Nydahl

Lövestam

et al. 2021

J Human Nutrition Diet

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Background Oral nutritional supplements (ONS) are commonly prescribed to patients with malnutrition. Dietitians have been suggested as preferred prescribers but generally lack ONS prescribing rights. How dietitians with prescribing rights experience their professional practice of prescribing ONS remains understudied. Thus, by exploring dietitians’ experiences of prescribing ONS, the present study aimed to obtain a deeper understanding of specific aspects that are of importance for dietitians when providing a nutrition therapy including ONS. Methods Qualitative individual interviews were conducted with 13 dietitians prescribing ONS to free‐living adult outpatients with malnutrition or at nutritional risk in the hospital or primary care setting. Systematic text condensation was used for data analysis. Results Two main categories signifying important aspects were identified and labelled: ‘Shared tailoring of the ONS prescription’ and ‘Supporting and facilitating ONS use’. First, the dietitians described tailoring the ONS prescription together with the patient, having their acceptance as a prerequisite, and being flexible regarding products and amounts prescribed. Second, they described performing different communication strategies and organising of practical issues (e.g., ONS delivery and support from others) to support and facilitate patients’ ONS usage. Conclusions The present study identifies patient involvement and the role of dietitians as behaviour change facilitators as two important aspects when dietitians prescribe ONS. These findings allow for dietitians’ ideals and strategies on how to prescribe ONS to be made more visible, which can inform both clinical practice and clinical trials for future improvements in nutrition therapy to address malnutrition.

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“…10 Criteria for the appropriate prescribing of ONS have been proposed, which encompass nutritional screening and assessment to ascertain the need for ONS; investigation of the underlying causes of malnutrition; establishing desirable outcomes to be obtained from the nutritional intervention (for example, weight increase); and providing both dietary advice and continuous ONS monitoring to assess patient adherence and ongoing need. 11 It is recommended that patients prescribed ONS should be reviewed every 3 months or, for those with longer term ONS requirements, every 6 months. 12 Previous research in Ireland identified a large number of patients prescribed ONS for more than 6 months without review, with 70% of prescriptions influenced by social factors, such as living alone, and difficulties with cooking and shopping.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis

et al. 2021

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BackgroundOral nutritional supplements (ONS) are recommended for patients at risk of malnutrition or malnourished. Appropriate ONS prescribing requires regular monitoring to assess its continued requirement. Previous research identified long-term ONS prescriptions (>6 months) without review, with 70% of these influenced by social factors.AimTo investigate the characteristics of ONS long-term users in Ireland and the determinants of larger volumes of ONS dispensing.Design and settingSecondary analysis of anonymous dispensed pharmacy claims data of patients dispensed standard ONS for 12 consecutive months in 2018 (n=912).MethodFactors showing significant (P<0.05) univariate associations with above the median consumption of ONS units were entered into a multivariable model.ResultsMedian age was 76 (range 18–101) years, with 66.9% of the sample being ≥65 years. Almost 70% of our sample was on polypharmacy (45.6%;≥5 medications) or excessive polypharmacy (21.5%;≥10 medications). Younger age and being on polypharmacy for drugs having an effect on the central nervous system (CNS) were significantly associated with being dispensed more ONS units in univariate and multivariate analysis. Those patients in the age range 18–44 were 2.5 fold more likely to be prescribed more ONS units (OR 2.5; 95% CI 1.5–4.25;P<0.001). Patients using CNS drugs or on CNS polypharmacy were more likely to be prescribed more ONS units (ORs 1.24 and 2.35; 95% CI 0.86–1.41 and 1.25–4.41 respectively; P=0.029).ConclusionOlder age and polypharmacy characterise long-term ONS users in this study. Younger age and CNS medication polypharmacy are predictors of more ONS units prescribed over a year.

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A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care

Cited by 16 publications

References 37 publications

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

A qualitative exploration of dietitians’ experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support

Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis

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