RESUMO
Background: Malnutrition is a cause and consequence of disease, affecting at least 3 million UK adults (Elia, 2010 [1]) of which 93% are in the community at a cost to the NHS of £13 billion/year, BDA [2]. Food should be first line treatment for anyone identified as at risk of malnutrition, Crawley and Hocking [3]. Oral nutritional supplements (ONS) are often inappropriately prescribed to treat malnutrition Gall et al. [4]. The current annual spend on ONS in Leeds is approximately £1.7million for around 1500 patients. This innovative service aims to receive 1000 new patient referrals and as a consequence make £300,000 of savings through clinical and cost effective use of ONS usage in the community. Process: The success of a pilot project led to the citywide dietetic-led service. This process is outlined below. Ethics approval was not required. 1. A 12 month pilot project in Leeds North CCG involved a retrospective audit which was carried out with 8 GP practices in 2011/12, to assess current ONS prescribing. Concurrently all Leeds North CCG practices could refer any adult patient on ONS, directly to the dietetic team. 2. This pilot project identified 315 people on ONS with 83 patients assessed and reviewed by a dietitian. The audit showed less than 20% of patients were appropriately prescribed ONS. Dietetic intervention made an average saving of £2.62 per patient per day by getting the right patient on the right product for the right length of time. This equates to an annual saving of £79,372.90. 3. The impact of this work led to investment (until 03/2014) to implement a city wide community ‘Eating and Drinking Team’ to raise awareness of the need to identify and treat malnutrition, through nutritional screening, promoting ‘food first’ principles, appropriate prescribing practices, and pathways, to ensure the best outcomes for Leeds residents. 4. Targets for the new team were set at 1000 new patient referrals, with 3000 patient contacts to enable annual cost savings of 20% per year (approx £300,000). Outcomes: In the first two full quarters of activity (Jan-Jun 2013), the service has: Cost savings are generated by preventing inappropriate prescribing by getting the right patient on the right product for the right length of time. Increase in referrals, activity and outcomes (not discussed here) demonstrate the need for a dietetic-led service, with additional and longer term investment to recognise the referral rate and the savings. Conclusion: Dietetic-led interventions for reducing the risk of malnutrition can be successful in promoting the role of the dietitian and achieving significant cost savings.