Malnutrition is common, yet under-diagnosed, amongst community-dwelling older adults(Reference Leij-Halfwerk, Verwijs and van Houdt1). General practitioners (GPs) are generally the first healthcare point of contact for older adults; however, currently there is little nutrition education in medical training and GPs report a lack of confidence in diagnosing and treating malnutrition(Reference Nowson2,Reference Castro P, Reynolds and Kennelly3) . To address this, GP interviews were carried out to establish preferences for the delivery and content of a malnutrition education programme and an online education module was designed. Efficacy of the module in improving knowledge and practice was evaluated.
Thirty-one GPs and GP trainees participated. The module covered the following topics: ‘malnutrition definition, prevalence and latest evidence’, ‘identifying malnutrition in clinical practice’, ‘food-first advice’, ‘reviewing malnutrition’ and ‘oral nutritional supplements’. Knowledge was measured using a multiple-choice questionnaire (MCQ). Practice was evaluated using patient case studies at baseline, immediately post-module completion, and 6-weeks post-module. Case studies involved calculations of weight loss, malnutrition risk scores, and approaches to treatment and follow-up, which were then reviewed by a clinical specialist dietitian for older adults. Evaluation forms assessing feedback from the module were also completed. Differences between assessment performance were investigated using paired t-tests.
MCQ scores increased significantly from baseline to immediately post-module (+25%, P < 0.001), with the greatest improvement in the ‘identifying malnutrition in clinical practice’ topic (+47%, P < 0.001). Eleven GPs completed the 6-week MCQ when scores remained significantly increased from baseline (+14%, P = 0.005), with the largest increase remaining in the ‘identifying malnutrition in clinical practice’ topic (+40%, P < 0.001). Seventeen GPs completed the case studies with 85% correctly calculating malnutrition risk scores at baseline, increasing to 94% post-module. Identification of appropriate approaches to malnutrition treatment improved by 33% after module completion. GP feedback about the module was positive.
This online education module was well-received by GPs and was successful in improving malnutrition knowledge and practice, with this improvement being retained in the short-term. Future development of nutrition online education tools that promote evidence-based practical learning may represent an effective way to improve nutrition care provided by GPs.
Acknowledgements
This project was funded by the Health Research Board (HRB) under a quality and patient safety funding stream (RCQPS-2017–4).
