NHD
Coeliac disease
what you need to know
by Fiona Moor, Dietetic Manager
Sip Feeds
A subject for debate?
by Chris Rudd, NHD Clinical Editor
Chris took early retirement last year after 33 years in continuous dietetic service. She has recently returned to part-time working with Sheffield PCT Medicines Management Team as a Dietetic Advisor.
Prescribing in the community has a com- mon link with two of our articles. Fiona Moor’s Coeliac Disease – what you need to know and Alison Smith’s report on Sip feeds: a subject for debate are both informative, encouraging us to think about appropriate prescribable items and their cost effectiveness.
The main themes for Medicines Man-
agement Teams (MMT) are focused on appropriate prescribing, cost effectiveness and reducing wastage. The cost of pre- scribed nutrition related products; enteral feeds, oral nutritional supplements (ONS), low protein and gluten-free items, increase year on year and, in many cases, MMT and GPs struggle to manage this. Have you thought how much these products cost? A 28-day prescription for a ready to drink ONS, based on 2/day is approximately £102 (£1326/year), 1500 ml/kcal enteral tube food is about £290/28 days (£3770/year) and 18 units of gluten- free items work out around £65/28 days
Whatever the cost . . .
(£845/yr/patient). If you then consider how many patients in the community are prescribed ONS, enteral tube feeds and gluten-free items, that is mega money! On reflection, in my post what have I con- cluded? There is inappropriate prescribing particularly for ONS, with patients not being nutritionally screened; underlying causes are not being identified and addressed; food first advice is not given nor is prescrib- ing meeting ACBS criteria. I feel that food first approach which may need foods fortifying or having texture modification is the foundation to nearly all treatments. Ap- propriate prescribing ought to follow a care pathway and reviews are essential. Presently the misuse or abuse of ONS is seen in a number of ways: GPs can al- most be ‘bullied’ by the patient’s relative or carer to prescribe ONS, as it is often seen as a cheap alternative to meals! There are cases where ONS are prescribed not for days or months but for years with the patients not being monitored or reviewed.
Returns of unused ONS to chemists is high and some care homes and nursing homes have unreasonable and large amounts of ONS stashed away, often not stock rotated.
Did you know that ONS have street value? I am told that substance misusers may immediately go and sell on their re- cently collected ONS. Car boots sales and ebay also trade in ONS! Sadly, it does finish there, as there is also evidence that gluten-free items are not only consumed by the individual who needs it, but by the whole family.
I was recently invited to a Strategic Health Authority Pharmacists’ meeting and the overwhelming outcome was that they desperately want dietitians to work in their MMT, so please watch in the future months for these jobs. I can assure you that it is enlightening, challenging and rewarding working with MMTs. For those who attend the BDA conference keep us informed of the outcome of the ‘big debate’.
NHD clinical - the essential clinical supplement
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