title: Prescribing of oral nutritional supplements in Primary Care: can guidelines supported by education improve prescribing practice?
abstract: OBJECTIVE
  With increasing resources being spent on nutritional supplements, this study sought to evaluate the effect of introducing guidelines on prescribing of supplements, by auditing practice, prior to, and after the implementation of guidelines.
  
  
  METHODS
  Prescribing practice was evaluated from patient interviews, and knowledge of health professionals examined from questionnaires from 50 GP practices. Training on the use of guidelines on prescribing supplements was implemented, incorporating a Nutritional Screening Tool and practical application of high-energy dietary advice, targeting GPs and Community Nurses.
  
  
  RESULTS
  Education to GPs and Community Nurses significantly reduced total prescribing by 15% and reduced the levels of inappropriate prescribing from 77% to 59% due to an improvement in monitoring of patients prescribed supplements. Although knowledge regarding high-energy dietary advice for nutritionally 'at risk' patients did improve as a result of the training, this was not demonstrated in practice. This lack of relevant dietary advice remained the main reason that inappropriate supplement prescriptions remained high.
  
  
  CONCLUSIONS
  Education on guidelines incorporating a Nutritional Screening Tool has proved to be an effective method of achieving more appropriate prescribing of supplements, suggesting the need for ongoing training of health professionals in Primary Care.
authors.affiliation: Dartford & Gravesham NHS Trust, Joyce Green Hospital, University Way, Dartford, Kent, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gall
authors.forename: J E
authors.initials: JE
authors.lastname: Harmer
authors.forename: H J
authors.initials: HJ
authors.lastname: Wanstall
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003152:Community Health Nursing / Q000193:education*; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D015596:Nutrition Assessment; D052756:Nutritional Sciences / Q000193:education*; D010353:Patient Education as Topic; D010821:Physicians, Family / Q000193:education*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires