Background & aim: Protein-energy malnutrition is under-recognised in the community despite being common in older adults due to physiological and social changes which are often compounded by chronic disease. This qualitative study aimed to explore the opinions of healthcare professionals (HCPs) working in the primary care and community settings about the management of malnutrition and the prescription of oral nutritional supplements (ONS), often included in the treatment of malnutrition. Methods: Twelve healthcare professional (HCP) focus groups with 75 participants were conducted: community dietitians (n ¼ 17), registered dietitians working in industry (n ¼ 5), community and residential care nurses (n ¼ 22), physiotherapists (n ¼ 12), pharmacists (n ¼ 9), occupational therapists (n ¼ 6) and speech and language therapists (n ¼ 4). Focus group discussions were audio-recorded and transcribed verbatim. The data were coded and analysed using thematic analysis and key themes with illustrative quotes extracted are presented. Results: Similar views on malnutrition management existed across professions. 'Gaps in Primary Care Management' was the first key theme wherein HCPs identified limitations in malnutrition management in the community. Barriers included limited or no dietetic services available in primary care and poor communication between general practitioners and wider primary care team members which resulted in inappropriate or delayed treatment. The second key theme, 'Challenges with ONS use in the Community', encapsulated several issues HCPs experienced with ONS usage including inappropriate prescribing and lack of monitoring of treatment goals. Conflicts of interest regarding dietitians working in industry assessing and treating older adults in residential care settings was highlighted by participants. Conclusions: This study highlights that more emphasis is needed to identify patients when they are at risk of malnutrition to avoid advanced or severe malnutrition presentations currently seen. Community
The involvement of healthcare professionals (HCPs) as research participants is essential to generate high quality evidence for enhancing health services and practice. Research teams face many challenges in recruiting HCPs for research, and barriers and enablers for interdisciplinary research are not well described in the literature. The Oral Nutritional Supplement Prescribing Malnutrition Research Study (ONSPres Study) examined malnutrition identification, management, and appropriate oral nutritional supplement prescribing in primary care in Ireland. The ONSPres Study offers a unique view of recruiting HCPs for research because a range of disciplines were sought for participation in a mixed methods study. The purpose of this open letter is to describe the experiences of recruitment and participation. Sixteen general practitioners (GPs) were recruited to participate in one-to-one interviews, eighty health and social care professionals working in community care (including nurses, pharmacists, dietitians, physiotherapists, speech and language therapists, and occupational therapists) were recruited to take part in 12 focus groups, and 31 GPs and trainee GPs were recruited to participate in an education programme developed by the study team. Strategies required to gain access and reach HCPs differed between disciplines. Professional networks enhanced access to HCPs working in practice and recruitment was slower and more tailored when those networks were less available to the team. An interest in malnutrition, to assist in research, to advance patient care, and the opportunity for learning were incentives for the participating HCPs. Limitations in the diversity of the sample arose, with a bias towards female participants and GPs motivated by an interest in the topic. It is recommended that study teams collaborate early with relevant HCP disciplines so they can contribute to recruitment planning at project concept and design stages. To enhance and incentivise HCP participation in research, dedicated time and acknowledgement of participation as continuous professional development is proposed.
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