Impact of a dietitian in general practice: Care of the frail and malnourished

Background: There is an increased demand in primary healthcare but general practitioner (GP) numbers are declining, creating significant challenges. Dietitians are ideal professionals to lead the treatment of patients with conditions that are amenable to dietary manipulation, including the management of malnutrition and frailty. The present study evaluated the benefits of a model of care in which a dietitian, working as a first contact practitioner within a general practice, provided care to patients at risk of malnutrition and frailty, aiming to reduce GP workload, improve patient care and make cost savings.

Methods: A service evaluation with a dietitian employed 6 h per week for 6 months. The practice database was screened for patients aged ≥65 years and electronic Frailty index 0.26-0.36 or body mass index <19 kg m^-2 . These patients were triaged by the dietitian and those at risk of malnutrition offered consultations. Patients prescribed oral nutritional supplements (ONS) and not under dietetic management were also seen.

Results: Approximately 1200 patients met the screening criteria; 189 (16%) patients were triaged by the dietitian. Most (75%) were at risk of malnutrition and 63 of these were seen. Improvements in strength, frailty and nutrition status were observed, and changes to ONS prescriptions in 27 patients equated to annual cost savings of £15,379. Patient satisfaction was high.

Conclusions: Dietitians, acting as first contact practitioners, can deliver significant improvements in care for older people at risk of malnutrition and frailty as part of the practice multi-disciplinary team. Cost savings for ONS were made and other potential cost saving were evident.