管理栄養士の訪問栄養指導RCTプロトコール論文

低栄養のリスクのある高齢者が病院から退院した後に、管理栄養士（RD）が訪問栄養指導することの有効性を検証するRCTの研究プロトコール論文を紹介します。

Beck AM, Kjaer S, Hansen BS, Storm RL, Thal-Jantzen K. Study protocol: Follow-up home visits with nutrition: a randomised controlled trial. BMC Geriatr. 2011 Dec 28;11(1):90. [Epub ahead of print]

下記のHPで全文見ることができます。

http://www.biomedcentral.com/content/pdf/1471-2318-11-90.pdf

低栄養リスクのある高齢者は自宅退院しても、再入院することが少なくありません。その原因の1つとして、低栄養もしくは低栄養リスクのまま自宅退院して、自宅で適切な食事・栄養療法をできていない可能性があります。先行研究で総合医（GP）と看護師による退院後のフォローアップは再入院を少なくすることがRCTで検証されています。

今回は管理栄養士（RD）による退院後フォローアップの有効性を検証するRCTになります。PECOは以下の通りです。

P：自宅退院する65歳以上の高齢者で低栄養リスクのある方に、
E：管理栄養士と総合医のフォローアップを12週間行うと、
C：総合医のみのフォローアップと比較して、
O：再入院が少なくなる。

この研究で訪問栄養指導の有効性が検証されれば、質の高いエビデンスとなります。日本での訪問栄養指導がより普及するきっかけとなるかもしれません。リハ栄養的には、介入群に必要時にはPT、OT、STのフォローアップも含むとすればなおよいですね。

ABSTRACT:
BACKGROUND: Geriatric patients are at high risk of re-admission after discharge. Pre-existing nutritional risk amongst these patients is of primary concern, with former nutritional intervention studies being largely ineffective. None of these studies has included individual dietary counselling by a registered dietician or has considered competing medical conditions in the participants. A former randomised study has shown that comprehensive discharge follow-up in geriatric patients homes by general practitioners and district nurses was effective in reducing the re-admission risk in the intervention group compared to the control group. That study did not include a nutritional intervention. The purpose of this study is to assess the combined benefits of an intervention consisting of discharge follow-up in geriatric patients' home by a general practitioner and a registered dietician.

Methods/design: This single-blind randomised controlled study, will recruit 180 hospitalised geriatric medical patients (65+ y) at nutritional risk. Participants will be randomly allocated to receive in their homes, either 12 weeks individualised nutritional counselling by a registered dietician complemented with follow-up by general practitioners or a 12 weeks follow-up by general practitioners alone.

DISCUSSION: This trial is the first of its kind to provide individual nutritional intervention combined with follow-up by general practitioner as an intervention to reduce risk of re-admission after discharge among geriatric medical patients. The results will hopefully help to guide the development of more effective rehabilitation programs following hospital admissions, which may ultimately lead to reduced health care costs, and improvement in mobility, independence and quality of life for geriatric patients at nutritional risk. Trial Registration: ClinicalTrials.gov 2010 NCT01249716.