A Pre-post Evaluation of an Ambulatory Nutrition Support Service for Malnourished Patients Post Hospital Sischarge: A Pilot Study



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    Introduction: Malnutrition is common among hospitalised patients, with poor followup of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients postdischarge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation.

    Materials and Methods: Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results.

    Results: In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5 kg to 46.3 ± 9.6 kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; P <0.001 for all. Seventy-four percent of patients improved in SGA score.

    Conclusion: Ambulatory nutrition support resulted in significant improvements in followup rate, nutritional status and quality of life of malnourished patients post-discharge.

    Malnutrition is common among hospitalised patients, with a prevalence ranging from 20% to 50%. Poor nutrition results in a range of negative clinical, functional and systemic outcomes. Malnutrition markedly increases morbidity and mortality in both acute and chronic diseases, of which trauma and heart failure are examples of each category respectively. Specifically, malnourished hospital patients have a 1.6 to 4.4 relative risk of death up to 3 years post-discharge in comparison to well-nourished patients.

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