PRESCRIPTION FOODS:- May 2011
From April 1, 2011 the funding and access criteria for some oral nutritional supplements and infant formula were changed. A wider range of practitioners (including GPs and dieticians) are now able to prescribe these products, according to Special Authority criteria based on international consensus.
Over the last several years there has been a steady growth in the prescribing of ready-mixed liquid feeds and elemental infant formula at a significant cost to the pharmaceutical budget. Similar trends have also been observed in other countries including the United Kingdom and Australia.
This increase is in part due to inappropriate or unnecessary prescribing, targeted advertising and a lack of review of the patients’ continuing need for a supplement. For example, there is a tendency to overuse ready-mixed sip feeds instead of taking steps to improve nutrition with simple “Food First” options, and expensive elemental amino acid formula tends to be prescribed first-line for cows’ milk protein allergy when it should be reserved for specific conditions.
This special edition booklet provides an update of some articles which appeared in BPJ 15 (Oct, 2008), as well as some new material, in the context of the issues outlined above. The main aim is to provide guidance on the optimal and cost effective use of oral nutritional supplements and infant formula.
Extensively hydrolysed formula for infants aged under six months and soy formula for infants aged over six months are the first-line choices for infants with cows’ milk protein allergy, without anaphylaxis. Amino acid formula is the first choice for infants with anaphylaxis due to cows’ milk protein allergy or eosinophilic oesophagitis.
People with a confirmed diagnosis of coeliac disease must adhere to a life-long gluten-free diet. When first diagnosed, nutritional status may be compromised and repletion doses of vitamins and minerals may be necessary. A small number of gluten-free foods are available, partially subsidised on the Pharmaceutical Schedule, however, a much greater range of products can be purchased from retail outlets.
The incidence and impact of malnutrition in older people is underestimated. The best option for treating malnutrition is to enhance normal eating and drinking. A “Food First” approach encourages eating frequent, small, high energy and protein meals and snacks. Nutritional supplements for weight gain are generally not required unless body weight is unable to be maintained with a normal balanced diet, or if food cannot be eaten safely.
People with COPD are generally underweight, have reduced muscle mass and are often malnourished, leading to other health problems. Opportunities for dietary intervention should be explored, aiming at early detection and early treatment of involuntary weight loss.
Did you miss the TV show about nutritional supplements and special foods on Sky on Thursday May 5th? Download here.
Feedback on the CPD quiz "PrescriptionFood" can be found here.
ACKNOWLEDGEMENT: Thank you to Sue MacDonell, Dietitian, Southern DHB, Clinical Tutor, Department of Human Nutrition, University of Otago, Dunedin for expert guidance in developing this special edition booklet.