How Remote Interventions Can Reduce the Impact of Disease-Related Malnutrition for Community Patients With Long-Term Conditions.

Nutrition is a critical part of health and development but over 3 million people in the UK are malnourished or at risk of malnutrition (93% living in the community). As part of a wider nutritional clinical review program across England, this specific pilot focused on proactive nutritional reviews within 1 rural practice, to explore how exacerbation of illness for patients with long-term conditions may be prevented and quality of life improved through the avoidance of malnutrition; identified through the timely delivery of holistic clinical assessments; and managed with nutritional interventions that patients actively engage with. These objectives were of particular significance in 2020 due to the challenges posed by Covid-19 in the delivery of healthcare. Within the pilot activity, a selection of patients at the practice were identified based on predetermined criteria. The intervention was delivered remotely by a clinical pharmacist. Two methods of communication with patients were explored during the pilot-initially communicating by letter, and latterly by telephone call. From a registered patient population of 6138, 59 of these patients were flagged to the practice for assessment as required and 102 patients were prioritized for remote assessment. Following a notes review, 60 patients were contacted via telephone with no action for 39 patients; 16 patients agreeing to a "food-first" approach; and 5 patients prescribed ONS. Results from the pilot and wider program activity demonstrate that patients willingly engaged in a proactive approach to remote assessments when using appropriate communication channels. It has also demonstrated that through guidelines adherence resulting in more appropriate prescribing, there are significant cost savings to be made through the implementation of remote nutritional assessments in primary care. Further research is required to address the system-wide benefit that these reviews and the identification of adults at risk of malnutrition could deliver.