A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care

Cathal A Cadogan; Rachel Dharamshi; Seán Fitzgerald; Clare A Corish; Patricia Domínguez Castro; Cristín Ryan

doi:10.1016/j.clnu.2019.03.003

A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care

Clin Nutr. 2020 Mar;39(3):654-663. doi: 10.1016/j.clnu.2019.03.003. Epub 2019 Mar 14.

Authors

Cathal A Cadogan¹, Rachel Dharamshi², Seán Fitzgerald³, Clare A Corish⁴, Patricia Domínguez Castro⁴, Cristín Ryan⁵

Affiliations

¹ School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: cathalcadogan@rcsi.ie.
² School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
³ School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁴ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; Institute of Food and Health, University College Dublin, Dublin, Ireland.
⁵ School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland.

PMID: 30910230
DOI: 10.1016/j.clnu.2019.03.003

Abstract

Background & aims: Oral nutritional supplements (ONS) are commonly used to treat malnutrition. Many patients are prescribed ONS without assessment of nutritional status. This conflicts with prescribing guidelines and has considerable cost implications. This scoping review aimed to provide an overview of interventions to improve appropriate ONS prescribing in primary care.

Methods: A systematic scoping review was undertaken. PubMed, EMBASE and CINAHL were searched from inception to September 2018. Studies meeting inclusion criteria had to: evaluate interventions targeting ONS prescribing in primary care; use a comparative evaluation; be published in English. Two reviewers independently screened abstracts and extracted data relating to study design, intervention characteristics, outcome assessments and key findings. Extracted data were collated using figures, tables and accompanying descriptive summaries.

Results: 10 studies met inclusion criteria. All studies involved uncontrolled before-and-after designs. Interventions ranged from dietitian-led reviews of patients prescribed ONS to transfer of ONS prescribing privileges from general practitioners to dietitians. Post-intervention results showed improvements in ONS prescribing based on study-specific assessments of prescribing appropriateness and absolute reductions in prescribing, as well as potential cost-savings.

Conclusions: This review provides a detailed overview of interventions aimed at improving appropriate ONS prescribing in primary care. Interventions evaluated to date most commonly involved dietitians. However, use of controlled experimental design was lacking. Lack of consistency in defining appropriate ONS prescribing and assessment outcomes was apparent. Future research should attend to rigour during intervention development, evaluation and reporting in order to generate findings which could inform relevant policy and practice.

Keywords: Malnutrition; Nutrition; Oral nutritional supplements; Prescribing; Primary care.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Administration, Oral
Dietary Supplements*
Humans
Malnutrition / drug therapy*
Nutritional Status*
Practice Patterns, Physicians' / statistics & numerical data*
Primary Health Care / methods*