Routine nutrition screening hit and miss in Thailand’s hospitals: Study

By Gary Scattergood contact

- Last updated on GMT

Routine nutrition screening was linked with a greater role for dieticians in Thailand's hospitals. ©iStock
Routine nutrition screening was linked with a greater role for dieticians in Thailand's hospitals. ©iStock

Related tags: Nutrition, Southeast asia

The small number of dieticians in Thailand’s hospitals along with the absence of national guidelines for nutrition screening and assessment are hampering efforts to make early interventions with patients who are at risk of malnutrition.

According to research carried out in the country, the actual prevalence of hospital malnutrition in Thailand is unclear.

Some studies have suggested it could be as high as 41%, but the exact number is difficult to quantify because a number of different measurement tools yield different results.

The two main validated assessment tools are Bhumibol Nutrition Triage (BNT) and Nutrition Alert Form (NAF).

Writing in Clinical Nutrition,​ the research team led by K Chittawatanarat from Chang Mai University, sought to identify the differences in pattern, process, and management of nutrition care in government hospitals in the country.

They used a combination of a quantitative nationwide questionnaire survey and focus group discussions to garner information.

“A total of 2300 questionnaires were sent to government hospitals across Thailand. The responders were divided by routine-nutrition screening/assessment unit vs. non-routine-nutrition screening/assessment unit (RSA vs. NRSA),”​ they wrote.

The results showed only 312 (38.3%) of the hospitals that responded had a routine nutrition screening system (RSA) in place.

The three most common tools of RSA were Bhumibol Nutrition Triage (BNT) at 42%, Subjective Global Assessment (SGA) at 21% and Nutrition Alert Form (NAF) at 20%.

During the focus group discussions, it became apparent that the main barrier of RSA implementation was the lack of national recommendation of a screening/assessment tool, inconsistency of policy and reimbursement, and professional and acceptable workload.

Guideline approach

The researchers also pointed out the greater role played by dieticians in hospitals which had an RSA system.

“Interestingly, the dietitian/nutritionist was observed to have an increasingly significant role in the RSA group, but the physician role was found to be less significant, in contrast,”​ they stated.

“These findings demonstrate that the RSA correlated with the alteration of team organization, guideline-oriented approach and re-arrangement of human resource utilization.”

They said  the roles of the dietitian and their impact on clinical nutrition management process in many South East Asian countries such as Singapore, Philippines and Malaysia, were clear to see.

They added that in Thailand, more “multidisciplinary nutrition support teams and the increased role of the dietitian/nutritionist in the nutrition care process might improve patient outcomes especially for those patients at risk of malnutrition.”

 

Source: Clinical Nutrition

DOI: http://dx.doi.org/10.1016/j.clnesp.2016.04.031

“Nationwide survey of nutritional management in an Asian upper-middle income developing country government hospitals: Combination of quantitative survey and focus group discussion”

Authors: K Chittawatanarat, et al.

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