Marsh Medical Practice & Primary Care Lincolnshire Medical Services GP Federation (PCLMS), Louth, Lincolnshire, UK.
Interface Clinical Services, Leeds, UK.
J Prim Care Community Health. 2022 Jan-Dec;13:21501319221096249. doi: 10.1177/21501319221096249.
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.
营养是健康和发育的关键组成部分，但英国有超过 300 万人营养不良或有营养不良风险（93%的人生活在社区中）。作为英格兰更广泛营养临床审查计划的一部分，本试点项目专门关注农村实践中的主动营养审查，以探索如何通过及时进行全面临床评估来预防慢性病患者病情恶化并改善生活质量，避免营养不良；并通过患者积极参与的营养干预措施来管理。由于 2020 年新冠疫情对医疗保健服务的挑战，这些目标显得尤为重要。在试点活动中，根据预定标准确定了实践中的一部分患者。临床药剂师通过远程提供干预措施。在试点期间探索了两种与患者沟通的方法——最初通过信件，后来通过电话。在注册患者人群 6138 人中，有 59 名患者根据需要被标记给该实践进行评估，有 102 名患者被优先进行远程评估。在查看病历后，通过电话联系了 60 名患者，其中 39 名患者未采取任何行动；16 名患者同意采用“先食疗”方法；5 名患者开了 ONS。试点和更广泛的项目活动的结果表明，当使用适当的沟通渠道时，患者愿意积极参与远程评估。它还表明，通过坚持指南导致更合理的处方，在初级保健中实施远程营养评估可以节省大量成本。需要进一步研究以解决这些审查和识别有营养不良风险的成年人可能带来的系统范围的益处。
