October 22, 2015

Undernutrition : How can telehealth support this new NHS priority?

NHS England has released new guidance this month – Commissioning Excellent Nutrition and Hydration 2015-2018. This document urges all commissioners to view nutrition and hydration as a priority, which is exciting for the world of dietetics and undernutrition service providers. The vision is that:

“All people will receive safe & high quality nutrition and hydration support when required, through the commissioning of patient centred and clinically effective integrated services in the community and health care commissioned settings’

The media focuses heavily on the burden of obesity in the UK, yet at the other end of the spectrum, undernutrition is largely ignored. Undernutrition is a very common issue, often thought to be restricted to third world countries and goes poorly recognised and treated. However, Bapen have found that a third of all secondary care and care home admissions are at risk of undernutrition, and is especially common in the elderly and frail.

It is common sense that an individual not gaining nourishment from eating and drinking for a prolonged period of time will become weak or ill, and can take longer to recover from illness. Unfortunately within health and social care the importance of food and drink has been forgotten. As a result the associated cost of undernutrition to the UK health economy has increase from £13bn per year to over £19bn over the last 8 years.

What I particularly like about the new nutrition and hydration guidance is the focus on patient centred care. Looking at what matters to the patients as in individual, rather than concentrating on a specific medical condition or pathway is essential.

How often do you hear stories of patients with multiple conditions having to take the same tests and examinations, or provide the same information over and over because the pathways for different conditions aren’t integrated? Patients don’t understand why the data one healthcare professional puts into a computer can’t be accessed by every member of their care team.

It reminds me of an advert a few years ago… the ideal scenario was that one hole was dug in the road for the gas, electric and phone company to do all the work they required in one go, not each company digging their own separate holes. Why can’t we take the analogy and implement integrated working into healthcare in a patient centric way?

NHS Health Call have developed an undernutrition service that works using a web based portal that will help health care providers do just that by collecting vital sign data such as weight, blood pressure, blood glucose and oxygen saturation, on a regular basis and collectively integrating the data into electronic patient records.

Integrated MDT’s will now be able to triage patients and prioritise their case loads meaning the right people are seen at the right time and reduces the need for patients to have repeated appointments or home visits. This leads the way in integrating nutrition in to all care pathways and making it everyone’s responsibility and not just a dietitian’s.

NHS Health Call’s undernutrition service has been shown to drive nutritional care within the care home setting. Using technology to regularly monitor weight amongst other vital signs will promote the importance of nutrition; clinicians, carers and patients should then start to see the link between improved nutrition and improved clinical outcomes and help make unintentional undernutrition a thing of the past.

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