Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Abstract

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

An exploration of the self-perceived nutrition competencies of pharmacists

“… 7 Interprofessional collaboration to deliver nutrition care has progressed in certain areas such as cancer 42 and palliative care, 43 however there is still room for improvement to drive dietary change and public education and identification of patients at risk of malnutrition. 2 , 44 , 45 Incomplete patient records and lack of shared communication between primary care providers has been highlighted as limiting the provision of clinical services by pharmacies. 46 Some feasibility studies have been carried out 46 including in the area of nutrition, but their application in community pharmacy practice in Ireland is as of yet non-existent.…”

“… 18 , 47 , 48 Those available are often supplied by companies promoting a product, as had been noted in a recent study. 2 This is concerning given that patient information leaflets are perceived to be valuable for improved health-related knowledge and satisfaction. 49 , 50…”

“…A greater emphasis is needed within primary care on interprofessional collaboration in the area of nutrition, as has been identified in previous studies. 2 , 7 Increased referrals between pharmacy and dietitians may require some training about when to refer. A recent paper found that pharmacists often interact with patients with nutrition concerns presenting for supplement advice, 14 which should be considered as an opportunity for identification of someone at risk and early intervention.…”

“…Nutrition care refers to any practice conducted by a health professional to support a patient to improve their dietary behaviours. 1 Pharmacists provide nutrition care to patients, carers and other health professionals including the supply and management of oral, parenteral and enteral nutritional products, 2 vitamins and minerals, and providing advice on drug-nutrient interactions 3 and disease specific support (e.g. renal,hepatic, gastrointestinal).…”

The Attitudes and Knowledge of Family Physicians Regarding Malnutrition in The Elderly: A Call for Action

“…Older adults, aged 70 years and above, are at even higher risk, due to a range of physiological and social factors, such as frailty, reduced appetite, sensory impairments, poor dentition, swallowing problems, depression, dementia, and even social isolation 3 . Malnutrition could have serious consequences on the individual, such as impaired healing of wounds, reduced immunity 4 , higher risk of falls 5 , impaired functionality 6 , increased mortality risks 7 , and decreased quality of life 8 .…”