Impact of a dietitian in general practice: Care of the frail and malnourished

Abstract

Background: There is an increased demand in primary healthcare but general practitioner (GP) numbers are declining, creating significant challenges. Dietitians are ideal professionals to lead the treatment of patients with conditions that are amenable to dietary manipulation, including the management of malnutrition and frailty. The present study evaluated the benefits of a model of care in which a dietitian, working as a first contact practitioner within a general practice, provided care to patients at risk of malnutrition and frailty, aiming to reduce GP workload, improve patient care and make cost savings. Methods: A service evaluation with a dietitian employed 6 h per week for 6 months. The practice database was screened for patients aged ≥65 years and electronic Frailty index 0.26-0.36 or body mass index <19 kg m -2 . These patients were triaged by the dietitian and those at risk of malnutrition offered consultations. Patients prescribed oral nutritional supplements (ONS) and not under dietetic management were also seen. Results: Approximately 1200 patients met the screening criteria; 189 (16%) patients were triaged by the dietitian. Most (75%) were at risk of malnutrition and 63 of these were seen. Improvements in strength, frailty and nutrition status were observed, and changes to ONS prescriptions in 27 patients equated to annual cost savings of £15,379. Patient satisfaction was high. Conclusions: Dietitians, acting as first contact practitioners, can deliver significant improvements in care for older people at risk of malnutrition and frailty as part of the practice multi-disciplinary team. Cost savings for ONS were made and other potential cost saving were evident.

Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions

“…Similarly, the impact of chronic diseases or conditions also needs to be considered in interventions for frailty. For example, a dietitian acting as a first contact practitioner for frail patients rather than a GP may be a cost-effective way to alter the nutritional status of frail patients (eFI 0.26–0.36) ( 89 ). Additionally, depression interacts with frailty (by the eFI) to further reduce the daily functioning of frail patients, suggesting that the clinical management of frailty should integrate physical and mental healthcare ( 90 ).…”

Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians

“…Those at higher risk have greater likelihood of negative health outcomes including hospitalization, falls, and increased comorbidity and mortality (Ramage-Morin et al, 2017). When identified early, nutrition risk can be significantly improved (Hickson et al, 2022).…”

Exploring complexities in nutritional support across the continuum of care

“…Improvements in strength, frailty and nutritional status were demonstrated and, as a result of the modification of prescriptions for oral nutritional supplements, substantial savings in resources were noted. 6 In nutritional support, management in both primary and secondary care research is identifying gaps in evidence; uncertainties within the evidence base and how improvements to the delivery of care can be implemented and then evaluated.…”

“…An example of a service evaluation that has demonstrated improvements in management of nutritional support has looked at dietetic practice in primary care. 6 In this service evaluation, a dietitian triaged patients and those at risk of malnutrition were subsequently assessed. Improvements in strength, frailty and nutritional status were demonstrated and, as a result of the modification of prescriptions for oral nutritional supplements, substantial savings in resources were noted.…”

“…This is demonstrated from exemplars where strong links with operational procedures have resulted in positive effects with respect to clinical outcomes, hospital length of stay, anthropometry and resource utilisation. 4,6 Research has demonstrated that dietitians are effective patient advocates in interdisciplinary care systems and key players in clinical decision making at the forefront of directing for patients with differing disease states throughout the continuum of care.…”