Abstract
ObjectivesMalnutrition is a common and significant public health problem, especially for older adults, as the consequences are costly. National guidelines (NICE CG32/QS24) highlight the need to identify and manage malnutrition, the implementation of which was deemed “high impact to produce cost savings”. The ‘Malnutrition Pathway’, endorsed by NICE and other professional bodies, is a practical evidence-based guide to help community healthcare professionals (HCP) to implement guidance on malnutrition management. Published evaluations of its use are needed.DesignThis service evaluation in older adults assessed the impact of implementing the ‘Malnutrition Pathway’ on health care use and costs, as well as the acceptability of the management strategies and effect on malnutrition risk.Setting5 GP surgeries in Gloucestershire.Participants163 older adults (80±9 years) with a range of primary diagnoses, living in their own home, were screened using the Malnutrition Universal Screening Tool (‘MUST’) (n50 low risk (LR); n41 medium risk (MR); n72 high risk (HR)). All patients were managed according to risk (LR: no further management; MR: dietary advice (DA); and HR: DA plus two oral nutritional supplements (ONS) (1 serve 300kcal, 18g protein; 125ml).MeasurementsAt each review (6weeks, 3 and 6 months), ‘MUST’ score, compliance and satisfaction to their management plan were recorded. Healthcare use was collected from GP records 6 months before and after implementation of the pathway. A simple cost analysis was completed.ResultsImplementing appropriate management of malnutrition led to significant reductions in hospital admissions (p=0.028), length of hospital stay (p=0.05), GP visits (p=0.007) and antibiotic prescriptions (p=0.05). Over 6 months, the costs to manage malnutrition (HCP time, ONS) were more than offset by the savings associated with these reductions in health care use (per patient savings of −£395.64 MR+HR; −£997.02 HR). The proportion of individuals at risk of malnutrition reduced over time, and patients reported being satisfied with the DA (97%) and ONS (96%), consuming 90% of their ONS prescription.ConclusionManaging malnutrition significantly reduces healthcare use, with a positive budget impact, in older malnourished patients in primary care. This represents an opportunity to improve patient care with benefit on health care spend.
Highlights
Malnutrition is a common and costly problem, with health and social care costs estimated to be around £23.5 billion per year in the UK [1], around 15% of the health and social care budget [2]
All 41 patients in the MR group were provided with DA and no nutrition support actions were taken with the patients in the LR group (n50)
In the High Risk (HR) group, there was a 62% reduction in hospital admissions (p=0.005), 67% reduction in length of hospital stay (p=0.004), 25% reduction in number of GP appointments (p=0.006); 39% reduction in number of antibiotic prescriptions (p=0.04) and 21% reduction in total number of healthcare professional visits (p=0.04) (Table 3)
Summary
Malnutrition is a common and costly problem, with health and social care costs estimated to be around £23.5 billion per year in the UK [1], around 15% of the health and social care budget [2]. To support community healthcare professionals a practical guide “Managing Adult Malnutrition in the Community” (“Malnutrition Pathway”) was developed which includes a pathway for management and guidance on the appropriate use of oral nutritional supplements (ONS) [7]. It was produced by a multi-professional consensus panel and endorsed by 10 professional bodies including the Royal College of General Practitioners, Royal Pharmaceutical Society, Royal College of Nursing, Primary Care Pharmacists Association, British Dietetic Association as well as NICE It was produced by a multi-professional consensus panel and endorsed by 10 professional bodies including the Royal College of General Practitioners, Royal Pharmaceutical Society, Royal College of Nursing, Primary Care Pharmacists Association, British Dietetic Association as well as NICE (https://www. malnutritionpathway.co.uk/library/managing_malnutrition.pdf)
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