Abstract

BOTELLA ROMERO, Francisco. Comprehensive approach for malnourished patients: aiming for continuity in nutritional support. Nutr. Hosp. [online]. 2018, vol.35, n.spe2, pp.34-38.  Epub Sep 21, 2020. ISSN 1699-5198.  https://dx.doi.org/10.20960/nh.1958.

Disease is the main cause of malnutrition in our health and social care settings, and it is associated with an increase in costs, as a result of more days of hospitalization, a greater number of complementary tests, the need for artificial nutritional support and / or drugs to treat complications, which is a very important economic burden.

Most patients who are malnourished, or at risk, can benefit from oral nutritional support, which includes dietary modifications (fortification, extra snacks, etc.), prescription of a personalized diet by a registered dietitian and the use of oral nutritional supplements (ONS).

The use of ONS has shown benefits, in several meta-analysis, in weight recovery, reduction in the number of complications or hospital readmissions and functional improvement, without a reduction in the usual food intake. The use of ONS is particularly cost-effective in certain subgroups of age (frail elderly), nutritional status (previous malnutrition) and underlying disease (hip fracture, abdominal surgery, etc.).

On the other hand, there are additional difficulties to evaluate the effect of nutritional support in different healthcare settings (community, nursing home, hospital) since the economic burden in one environment often has an impact on another (for example: hospital readmissions). This circumstance makes it difficult for regulators to control the prescription and generates debate about the continuity of treatments in different settings.

The repercussion of an episode of hospitalization on functional status, 30 days after discharge ("post hospital syndrome"), constitutes a transitory period of special vulnerability for comorbidity and hospital readmission risk. The nutritional support (dietary counselling + use of ONS) generates savings of around 5% of the health cost in the intervention group vs "usual practice", together with a significant decrease in the number of hospital readmissions.

The nutritional support throughout the different scenarios where the patient is found has proven to be cost-effective, does not involve extra costs per unit of improvement, both clinical and functional, and can be defended from a health economic perspective. These results highlight the need to pay attention to the detection of malnutrition and its treatment as part of standard medical care in the transition process between the hospital and the patient's home.

It is the responsibility of the health managers to ensure that the detection and treatment of malnutrition is routinely carried out in their centers, as well as integrating clinical nutrition into standardized medical care. of any patient, which raises the importance of including clinical nutrition in the training plans of the health personnel.

Keywords : Malnutrition; Disease-related malnutrition; Oral nutritional supplements; Compliance; Nutritional treatment continuity.

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