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Original article

Vol. 147 No. 3132 (2017)

Prescription and indication for oral nutritional supplements in a Swiss university hospital: a prospective survey

DOI
https://doi.org/10.4414/smw.2017.14475
Cite this as:
Swiss Med Wkly. 2017;147:w14475
Published
03.08.2017

Summary

AIMS OF THE STUDY

Patients with an acute or chronically negative nutritional balance are at nutritional risk. Oral nutritional supplements (ONS) are simple and effective medical treatments of nutritional risk. In the ambulatory setting, in Switzerland, ONS are reimbursed by public insurance under conditions defined by Swiss Society for Clinical Nutrition. The reimbursement requires a medical prescription for ONS and their delivery at the patient’s home by a homecare service. The indication for the ONS, defined as a Nutritional Risk Screening-2002 (NRS-2002) score ≥3, must also be present. This survey aimed to document: (i) the existence of a medical prescription for ONS during hospitalisation and discharge for home, (ii) the adequacy of the indication for ONS during hospitalisation and at discharge for home, and (iii) the continuation or not of ONS treatment 1 month after discharge for home.

METHODS

This prospective survey included adult patients hospitalised in the departments of surgery, medicine or rehabilitation and who were about to receive ONS for the first time. Patients already on ONS, with major consciousness disorders, who refused to take ONS or to participate to the survey were excluded. The existence of a medical prescription for ONS and the adequacy of the indication (Nutritional Risk Screening-2002 [NRS-2002] score ≥3) were evaluated at first ONS delivery and at hospital discharge. At home, the continuation of ONS consumption was evaluated by the homecare service 1 month after discharge. Results are presented as mean ± standard deviation or frequencies and percentages, and comparisons between patients with and without ONS at discharge for home.

RESULTS

A total of 416 patients (age 71.7 ± 14.1 yr, 52.6% male, body mass index 23.6 ± 5.2 kg/m2) were included. At the first delivery of ONS, 44.5% (n = 185) of patients had no medical prescription for the supplements, and 82.7% (n = 344) had an NRS-2002 score ≥3. Out of 207 patients discharged for home, only 24.2% (n = 50) had an adequate homecare ONS prescription and 68% (n = 141) had a NRS-2002 score ≥3. One month after discharge for home, 76% (n = 29) were still taking ONS.

CONCLUSIONS

In our survey, only few patients receiving ONS during the hospital stay had a medical prescription for ONS during the hospitalisation and at discharge for home. For most patients receiving ONS during hospitalisation and at discharge for home, an NRS-2002 score of ≥3 was present. If a medical prescription was provided, ONS were generally continued one month after discharge for home.

Clinical trial registration number

NCT02476110

References

  1. Thibault R, Makhlouf AM, Kossovsky MP, Iavindrasana J, Chikhi M, Meyer R, et al. Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study. PLoS One. 2015;10(4):e0123695. doi:.https://doi.org/10.1371/journal.pone.0123695
  2. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9. doi:.https://doi.org/10.1016/S0261-5614(02)00215-7
  3. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345–50. doi:.https://doi.org/10.1016/j.clnu.2011.11.001
  4. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, et al.; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008;27(3):340–9. doi:.https://doi.org/10.1016/j.clnu.2008.03.012
  5. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5–15. doi:.https://doi.org/10.1016/j.clnu.2007.10.007
  6. Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, Stäubli M, et al. Prevalence of undernutrition on admission to Swiss hospitals. Clin Nutr. 2010;29(1):38–41. doi:.https://doi.org/10.1016/j.clnu.2009.06.005
  7. Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11(2):278–96. doi:.https://doi.org/10.1016/j.arr.2011.12.008
  8. Stratton RJ, Marinos E. A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin Nutr. 2007;2(Suppl. 1):5–23.
  9. Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370–80. doi:.https://doi.org/10.1016/j.clnu.2015.05.010
  10. Elia M, Normand C, Laviano A, Norman K. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clin Nutr. 2016;35(1):125–37. doi:.https://doi.org/10.1016/j.clnu.2015.07.012
  11. Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, et al.; NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016;35(1):18–26. doi:.https://doi.org/10.1016/j.clnu.2015.12.010
  12. Zhong Y, Cohen JT, Goates S, Luo M, Nelson J, Neumann PJ. The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients. Appl Health Econ Health Policy. 2017;15(1):75–83.
  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi:.https://doi.org/10.1016/0021-9681(87)90171-8
  14. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M ; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21. doi:.https://doi.org/10.1016/S0261-5614(03)00098-0
  15. Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Who receives oral nutritional supplements in nursing homes? Results from the nutritionDay project. Clin Nutr. 2016;S0261-5614(16)31243-2.
  16. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr. 2012;31(3):293–312. doi:.https://doi.org/10.1016/j.clnu.2011.11.020
  17. den Uijl LC, Kremer S, Jager G, van der Stelt AJ, de Graaf C, Gibson P, et al. That’s why I take my ONS. Means-end chain as a novel approach to elucidate the personally relevant factors driving ONS consumption in nutritionally frail elderly users. Appetite. 2015;89:33–40. doi:.https://doi.org/10.1016/j.appet.2015.01.016
  18. Elia M, Zellipour L, Stratton RJ. To screen or not to screen for adult malnutrition? Clin Nutr. 2005;24(6):867–84. doi:.https://doi.org/10.1016/j.clnu.2005.03.004
  19. Kennelly S, Kennedy NP, Corish CA, Flanagan-Rughoobur G, Glennon-Slattery C, Sugrue S. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices. J Hum Nutr Diet. 2011;24(5):496–504. doi:.https://doi.org/10.1111/j.1365-277X.2011.01197.x
  20. Gall MJ, Harmer JE, Wanstall HJ. Prescribing of oral nutritional supplements in Primary Care: can guidelines supported by education improve prescribing practice? Clin Nutr. 2001;20(6):511–5. doi:.https://doi.org/10.1054/clnu.2001.0479

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