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Research

Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis

Patricia Dominguez Castro, Ciara Reynolds, Maria Gabriella Bizzaro, Sharon Kennelly, Barbara Clyne, Gerard Bury, Catriona Bradley, Karen Finnigan, Laura McCullagh, Celine Murrin, Carla Perrotta, Eileen R Gibney and Clare A Corish
BJGP Open 2021; 5 (2): BJGPO.2020.0131. DOI: https://doi.org/10.3399/BJGPO.2020.0131
Patricia Dominguez Castro
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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Ciara Reynolds
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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Maria Gabriella Bizzaro
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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Sharon Kennelly
3 National Primary Care Division, Community Funded Schemes Service Improvement, Mountmellick Primary Care Building, Co. Laois, Republic of Ireland
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Barbara Clyne
4 HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
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Gerard Bury
5 School of Medicine, University College Dublin, Belfield, Dublin, Republic of Ireland
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Catriona Bradley
6 Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
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Karen Finnigan
7 Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Republic of Ireland
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Laura McCullagh
7 Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Republic of Ireland
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Celine Murrin
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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Carla Perrotta
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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Eileen R Gibney
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
8 School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
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Clare A Corish
1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2 UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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  • For correspondence: clare.corish@ucd.ie
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1. Percentage of oral nutritional supplements (ONS) product type dispensed to long-term ONS users (n = 912) as per Supplementary Table 2. CHO = Community Health Organisation.
  • Figure 2.
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    Figure 2. Percentage of oral nutritional supplements (ONS) product type dispensed to ONS long-term users (n = 912), segregated by patient age category. (P<0.001).

Tables

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    Table 1. PCERS patients and GPs characteristics
    Characteristic
    Individuals on ONS, n = 912%Median (range)
    Sex
    Male43.5
    Female56.5
    Age 76 (18 to 101)
    ≥18 to 44 years11.3
    ≥45 to 64 years21.8
    ≥65 years66.9
    Area
    South/south east Dublin16.0
    West/south west Dublin41.4
    North/north west Dublin42.5
    Residential status
    Living in residential care18.2
    Living independently81.7
    Number of ONS products in 2018 1 (1 to 4)
    Number of ONS units in 2018 660 (12 to 3250)
    Patients on more than 1 ONS 10.0
    Patients on ONS previous year 96.2
    Number of medications 6.0(0 to 18)
    Polypharmacy
    No polypharmacy (<5 drugs)32.9
    Polypharmacy (≥5 drugs)45.6
    Excessive polypharmacy (≥10)21.5
    Patient CNS drug dispensed a
    No CNS drug24.8
    CNS drug (<5 drugs)65.9
    CNS polypharmacy or excessive polypharmacy (≥5 drugs)9.3
    Patient circulatory drug dispensed b
    No circulatory drug38.4
    Circulatory drug (<5 drugs)42.7
    Circulatory polypharmacy or excessive polypharmacy (≥5 drugs)19.0
    GPs, n = 405
    Sex
    Male59.0
    Female41.0
    Age 53 (33 to 72)
    ≥18 to 44 years23.2
    ≥45 to 64 years61.5
    ≥65 years15.3
    Area
    South/south east Dublin23.2
    West/south west Dublin35.1
    North/north west Dublin39.3
    Otherc 2.5
    Number of patients on ONS 2 (1 to 17)
    GPs with > 2 patients on ONS 27.9
    • aCNS medication include drugs to treat anxiety; insomnia; psychoses; mood disorders; obsessive compulsive disorder; nausea; vomiting; vertigo; epilepsy and seizures; Parkinson's; Alzheimer's; multiple sclerosis; attention deficit hyperactivity disorder, and narcolepsy. bCirculatory medication include drugs to treat hypertension; oedema; heart failure; arrhythmias; angina; prevent myocardial infarction, stroke, and vascular events; hypercholesterolaemia; vascular diseases such as Raynaud's and pulmonary arterial hypertension; haemorrhage; anaemia and neutropenia. cA minority of patients attended GPs with practices in different areas to their residential area.

    • CNS = central nervous system. GP = general practitioner. ONS = oral nutritional supplements. PCERS = Primary Care and Eligibility Reimbursement Service.

    • View popup
    Table 2. PCERS patients characteristics segregated by residential status
    CharacteristicMedian or %P value
    Living in privatenursing homeLiving independently
    Ag e, years ( n = 912) 87 (58 to 101)71 (18 to 100) P<0.001
    Sex
    Male11.388.7
    Female23.776.3 P<0.001
    Area ( n = 912)
    South/south east Dublin17.415.7
    West/south west Dublin47.340.1
    North/north west Dublin35.344.2 P=0.110
    Number of ONS units in 2018 ( n = 912 ) 600 (30 to 3192)672 (12 to 3250) P=0.540
    Patients on more than 1 ONS, n = 91218.68.2 P<0.001
    Patients on ONS previous year92.896.9 P=0.023
    Number of medications 7 (0 to 18)6 (0 to 18) P=0.021
    Polypharmacy
    No polypharmacy (<5 drugs)21.035.6
    Polypharmacy (≥5 drugs)55.743.4
    Excessive polypharmacy (≥10)23.421.1 P=0.001
    Patient CNS drug dispensed a
    No CNS drug17.426.4
    CNS drug (<5 drugs)74.364.0
    CNS polypharmacy or excessive polypharmacy (≥5 drugs)8.49.5 P=0.032
    Patient c irculatory drug dispensed b
    No circulatory drug33.539.5
    Circulatory drug (<5 drugs)51.540.7
    Circulatory drug polypharmacy or excessive polypharmacy (≥5 drugs)15.019.9 P=0.035
    • aCNS medication include drugs to treat anxiety; Insomnia; psychoses; mood disorders; obsessive compulsive disorder; nausea; vomiting; vertigo; epilepsy and seizures; Parkinson's; Alzheimer's; multiple sclerosis; attention deficit hyperactivity disorder, and narcolepsy. bCirculatory medication include drugs to treat hypertension; oedema; heart failure; arrhythmias; angina; prevent myocardial infarction, stroke, and vascular events; hypercholesterolaemia; vascular diseases such as Raynaud's and pulmonary arterial hypertension; haemorrhage; anaemia and neutropenia.

    • CNS = central nervous system. ONS = oral nutritional supplements. PCERS = Primary Care and Eligibility Reimbursement Service.

    • View popup
    Table 3. Univariate analysis with characteristics of patients and GPs in the oral nutritional supplements (ONS) user and high ONS user groups
    <660 ONS units≥660 ONS units
    Characteristicn%n%P-value
    Patients
    S ex
    Male18145.621654.4
    Female27453.223646.80.023
    A r ea ( n = 912 )
    South/south east Dublin8457.56242.5
    West/south west Dublin18448.719451.3
    North/north west Dublin18748.220151.80.130
    Residential status
    Living in a private nursing home9053.97746.1
    Living independently36549.038051.00.270
    A ge category
    ≥18 to 44 years3433.76766.3
    ≥45 to 64 years6331.713668.3
    ≥65 years35858.725241.3<0.001
    Type of ONS a
    ONS type 123945.728454.3
    ONS type 220864.011736.0<0.001
    G eneral p olypharmacy
    No polypharmacy (<5 drugs)12842.717257.3
    Polypharmacy (≥5 drugs)22253.419446.6
    Excessive polypharmacy (≥10 drugs)10553.69146.40.009
    CNS drug dispensed b
    No CNS drug12555.310144.7
    CNS drug (<5 drugs)30250.229949.8
    CNS polypharmacy or excessive polypharmacy (≥5 drugs)2832.95767.10.002
    C irculatory drug dispensed c
    No circulatory drug14641.720458.3
    Circulatory drug (<5 drugs)20753.218246.8
    Circulatory polypharmacy or excessive polypharmacy (≥5 drugs)10259.07141.0<0.001
    GP s
    Sex
    Male29449.530050.5
    Female16150.615749.40.781
    A ge category
    ≥18 to 44 years11346.313153.7
    ≥45 to 64 years26351.824548.2
    ≥65 years7949.48150.60.370
    A rea
    South/south east Dublin10254.08746.0
    West/south west Dublin16149.116750.9
    North/north west Dublin18247.620052.4
    Other1076.9323.10.116
    • aThis variable only includes those patients who were on one ONS type, ONS type 1 includes the two most common type of ONS as per Figure 2 (high energy and very high energy standard protein sip feed with or without fibre), ONS type 2 includes the other ONS types represented in Figure 2 (high energy shots, high protein sip feed, high energy semi-solid, textured modified high energy/high protein sip feeds). bCNS medication include drugs to treat anxiety; insomnia; psychoses; mood disorders; obsessive compulsive disorder; nausea; vomiting; vertigo; epilepsy and seizures; Parkinson's; Alzheimer's; multiple sclerosis; attention deficit hyperactivity disorder, and narcolepsy. cCirculatory medication include drugs to treat hypertension; oedema; heart failure; arrhythmias; angina; prevent myocardial infarction, stroke, and vascular events; hypercholesterolaemia; vascular diseases such as Raynaud's and pulmonary arterial hypertension; haemorrhage; anaemia and neutropenia.

    • CNS = central nervous system. GP = general practitioner. ONS = oral nutritional supplements.

    • View popup
    Table 4. Multivariable analysis with characteristics of patients significant in univariate analysis in the ONS users and high ONS users groups
    CharacteristicsUnadjustedaAdjustedb
    95% CI95% CI
    LowerUpperLowerUpper
    ORPPOR
    Patient sex
    Male1.0c 1.0c
    Female0.70.0230.601.00.99301.00.71.4
    Patient age category
    ≥18 to 44 years2.91.94.52.51.54.3
    ≥45 to 64 years3.12.24.32.51.73.7
    ≥65 years1.0c <0.001<0.0011.0c
    Type of ONS d
    ONS type 11.0c 1.0c
    ONS type 20.5<0.0010.40.6<0.0010.60.40.8
    Patient p olypharmacy
    No polypharmacy (<5 drugs)1.0c 1.0c
    Polypharmacy (≥5 drugs)0.70.50.90.80.61.2
    Excessive polypharmacy (≥10)0.60.0100.50.90.5500.80.51.3
    Patient CNS drug dispensed e
    No CNS drug1.0c 1.0c
    CNS drug (<5 drugs)1.20.91.71.20.91.8
    CNS polypharmacy or excessive polypharmacy (≥5 drugs)2.50.0021.54.30.0292.41.34.4
    Pati ent circulatory drug dispensed f
    No circulatory drug1.0c 1.0c
    Circulatory drug (<5 drugs)0.60.50.81.00.71.4
    Circulatory polypharmacy or excessive polypharmacy (≥5 drugs)0.5<0.0010.30.70.9600.90.61.5
    • aBinary logistic regression carried out with each variable individually as predictor of dependent variables. bBinary logistic regression carried out with full model adjusted for all variables as predictors of dependent variables. cIndicates reference group d This variable only includes those patients who were on one ONS type, ONS type 1 includes the two most common type of ONS as per Figure 2 (high energy and very high energy standard protein sip feed with or without fibre), ONS type 2 includes the other ONS types represented in Figure 2 (high energy shots, high protein sip feed, high energy semi-solid, textured modified high energy/high protein sip feeds). eCNS drugs include drugs to treat anxiety, insomnia, psychoses, mood disorders, obsessive compulsive disorder, nausea, vomiting, vertigo, epilepsy and seizures, Parkinson's, Alzheimer's, multiple sclerosis, attention deficit hyperactivity disorder, and narcolepsy. fCirculatory medication include drugs to treat hypertension; oedema; heart failure; arrhythmias; angina; prevent myocardial infarction, stroke, and vascular events; hypercholesterolaemia; vascular diseases such as Raynaud's and pulmonary arterial hypertension; haemorrhage; anaemia and neutropenia.

    • CI = confidence interval. CNS = central nervous system. ONS = oral nutritional supplements. OR = odds ratio.

Supplementary Data

  • BJGPO.2020.0131.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

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Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis
Patricia Dominguez Castro, Ciara Reynolds, Maria Gabriella Bizzaro, Sharon Kennelly, Barbara Clyne, Gerard Bury, Catriona Bradley, Karen Finnigan, Laura McCullagh, Celine Murrin, Carla Perrotta, Eileen R Gibney, Clare A Corish
BJGP Open 2021; 5 (2): BJGPO.2020.0131. DOI: 10.3399/BJGPO.2020.0131

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Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis
Patricia Dominguez Castro, Ciara Reynolds, Maria Gabriella Bizzaro, Sharon Kennelly, Barbara Clyne, Gerard Bury, Catriona Bradley, Karen Finnigan, Laura McCullagh, Celine Murrin, Carla Perrotta, Eileen R Gibney, Clare A Corish
BJGP Open 2021; 5 (2): BJGPO.2020.0131. DOI: 10.3399/BJGPO.2020.0131
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Keywords

  • Malnutrition
  • Protein-energy malnutrition
  • oral nutritional supplements
  • polypharmacy
  • prescriptions
  • pharmacy
  • general practice
  • primary care

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