Document Type

Theses, Ph.D

Rights

This item is available under a Creative Commons License for non-commercial use only

Disciplines

Nutrition, Dietetics

Publication Details

Successfully submitted for the award of Doctor of Philosophy (Ph.D.) to the Dublin Institute of Technology January, 2012.

Abstract

Evaluation of a community dietetics intervention to improve oral nutritional supplement prescribing practices in the community. Background: Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines and expenditure on ONS has increased. The aim of this study was to investigate ONS prescribing practices and to determine the impact of a community dietetics intervention on these practices and expenditure one year later. Methods: At baseline ONS prescribing practices were investigated by patient interview with a community dietitian. The intervention involved an education programme for general medical practitioners (GPs), practice nurses, nurses in nursing homes and community nurses together with the provision of a new community dietetics service. Changes in healthcare professionals‟ practices and knowledge were determined by selfadministered questionnaires immediately after and six months after the intervention, and by examining community dietetics records one year after the intervention. ONS prescribing volume and expenditure were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Results: Seventy-eight and 42 patients were included in the study pre and postintervention respectively. Ninety-six healthcare professionals participated in the nutrition education programme (including seven of ten principal GPs). Six months post-intervention improvement in healthcare professional nutritional knowledge was observed (P<0.001). One year post-intervention, screening for malnutrition risk was better (62% vs 0%, P < 0.001), dietary advice provided more often (90% vs 26%, P < 0.001), and ONS prescribed for a greater proportion of patients who were at „high risk‟ of malnutrition than before (88% vs 37%, P < 0.001). There was a trend (not significant) towards fewer patients being prescribed ONS (18% reduction, P = 0.074) and there was no significant change in expenditure on ONS by participating GPs (3% reduction, P = 0.499), despite a 28% increase nationally by GPs on ONS. Conclusion: The community dietetics intervention improved ONS prescribing practices by healthcare professionals, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention.

SharThApp1a.pdf (503 kB)
Appendix 1

SharTApp2a.pdf (501 kB)
Appendix 2

SharTApp3_4.pdf (311 kB)
Appendix 3 and 4

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