Plymouth Institute of Health Research, University of Plymouth, Plymouth, UK.
NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Plymouth, Plymouth, UK.
J Hum Nutr Diet. 2022 Feb;35(1):145-153. doi: 10.1111/jhn.12942. Epub 2021 Sep 5.
There is an increased demand in primary healthcare but general practitioner (GP) numbers are declining, creating significant challenges. Dietitians are ideal professionals to lead the treatment of patients with conditions that are amenable to dietary manipulation, including the management of malnutrition and frailty. The present study evaluated the benefits of a model of care in which a dietitian, working as a first contact practitioner within a general practice, provided care to patients at risk of malnutrition and frailty, aiming to reduce GP workload, improve patient care and make cost savings.
A service evaluation with a dietitian employed 6 h per week for 6 months. The practice database was screened for patients aged ≥65 years and electronic Frailty index 0.26-0.36 or body mass index <19 kg m . These patients were triaged by the dietitian and those at risk of malnutrition offered consultations. Patients prescribed oral nutritional supplements (ONS) and not under dietetic management were also seen.
Approximately 1200 patients met the screening criteria; 189 (16%) patients were triaged by the dietitian. Most (75%) were at risk of malnutrition and 63 of these were seen. Improvements in strength, frailty and nutrition status were observed, and changes to ONS prescriptions in 27 patients equated to annual cost savings of £15,379. Patient satisfaction was high.
Dietitians, acting as first contact practitioners, can deliver significant improvements in care for older people at risk of malnutrition and frailty as part of the practice multi-disciplinary team. Cost savings for ONS were made and other potential cost saving were evident.
初级保健需求增加，但全科医生人数正在减少，这带来了巨大的挑战。营养师是理想的专业人士，可以领导治疗那些可以通过饮食干预治疗的患者，包括管理营养不良和虚弱。本研究评估了一种护理模式的益处，即营养师作为全科医生的第一接触从业者，为有营养不良和虚弱风险的患者提供护理，旨在减轻全科医生的工作量，改善患者护理并节省成本。
对一名营养师进行了服务评估，该营养师每周工作 6 小时，为期 6 个月。对年龄≥65 岁且电子虚弱指数为 0.26-0.36 或体重指数 <19 kg/m2 的患者进行了实践数据库筛查。营养师对这些患者进行了分诊，对有营养不良风险的患者提供咨询。还对接受口服营养补充剂（ONS）治疗但未接受饮食管理的患者进行了检查。
大约有 1200 名患者符合筛查标准；189 名（16%）患者由营养师分诊。大多数（75%）有营养不良风险，其中 63 名患者接受了治疗。观察到力量、虚弱和营养状况的改善，27 名患者的 ONS 处方改变相当于节省了 15379 英镑的年度费用。患者满意度很高。
营养师作为第一接触从业者，可以为有营养不良和虚弱风险的老年人提供护理方面的显著改善，作为实践多学科团队的一部分。ONS 的成本节省，其他潜在的成本节省也很明显。
