Empowering patients with flexible choices for oral nutrition supplements (ONS) may just be the key to the tricky issue of compliance. Improving compliance is a complicated issue. This is, for the most part, because there is no single reason for non-compliance. The reasons are as wide and varied as the patients themselves. ¹⁻³
A recent cross-sectional study looking at compliance to ONS among hospital outpatients, prescribed 1–3 bottles of ONS/day for more than one month, reported an impressive 93% success rate. ⁴ The main reason suggested for such a high compliance rate was that the patients had been greatly involved in their choice of ONS; and had been supplied with tailored prescriptions which were flexible to meet their personal needs. ⁴
Prescribed Amounts of ONS
Although prescribed amounts will vary between patients, many consider an effective dose of ONS to be around two sachets/bottles per day (depending on the product), providing approximately 500-600 kcal daily. ⁵⁻⁷ Some patients will require as much as three sachets/bottles per day, meaning they may be required to drink at least 600ml a day, alongside food and other drinks.
Treating the Patient as an Individual – Offer Flexible Options
How and when a patient takes their ONS depends very much on personal preference. “Usual practice” or “standard prescriptions” (e.g., 1-3 standard 200ml ONS bottles) may not be ideal for all patients. In a recent survey examining ONS prescribing experiences of thirteen dietitians, the dietitians described ideal ONS prescribing as flexible and adjustable, with an extensive variety of products available for prescription. The process of finding ‘the right’ ONS that the patient liked (i.e., in terms of style, volume and flavour) and accepted was considered important. ⁸
Flexible serving sizes, options to split drinks into smaller portions, and the use of low volume, high energy ONS products can be useful additions to a tailored ONS prescription. Having fewer ONS bottles each day could also be more practical and less overwhelming for the patient.
An Ideal Approach to ONS Prescriptions
- Involve the patient in decision making. Ask how ONS will work best for them.
- Ask about preferred flavours, likes and dislikes and preferred volumes.
- Consider the patient’s storage space for ONS items (i.e., fridge and cupboard capacity).
- “Try before you buy”- testing things out with a ‘starter pack’ (which offers a range of products/flavours) or samples. Adjust as needed. ⁷
- Decide, together, on a plan including suitable times to take ONS (such as between meals, or during medication rounds).
- Arrange for preferred flavours to be mixed in throughout the patient’s personal plan.
- According to patient preference, include innovative ONS products with flexible volumes (e.g., high-energy, low volume ONS, splitting drinks into smaller volumes through the day, if needed).
- Include ways to add ONS into the patient’s fortified meal plan (e.g., adding into puddings, sauces and smoothies).
- Offer innovative serving solutions adding variety for your patients throughout the day. For example, serve chilled, over ice or freeze ONS into ice lollies.
ActaGain 600 Allows for Patient Flexibility
Fortunately, there are innovative ONS products available, developed in-line with feedback from healthcare professionals (HCPs) and patients. This provides HCPs more opportunities to create flexible ONS prescriptions to meet their patient’s needs.
ActaGain 600 is a high-energy, low volume ONS (2.4kcal/ml), designed especially for patients with high energy needs who struggle with volume and/or who might simply prefer smaller doses served more frequently.
ActaGain 600 contains 600 kcal and 24g of protein per 250ml bottle. Having one bottle makes it easier to store in the fridge and reduces the hassle of carrying home a 28-day order from the pharmacy, making life simpler for patients.
Each resealable bottle can be split into preferred doses, (e.g., 2x 125ml or 4 x 62.5ml), to be taken whenever the patient prefers. Additionally, each ActaGain 600 bottle is the equivalent of 2 x 125ml compact ONS, meaning that the number of bottles provided to each patient is halved, leading to less packaging and waste.
A recent patient study with ActaGain 600 reported 100% acceptability and demonstrated 90.8% compliance for patients consuming the product in 2 x 125ml doses and 95% compliance for those consuming 4 x 62.5ml doses each day. ⁹
- Ginzburg Y, et al. (2018). Barriers for nutritional care in the transition from hospital to the community among older patients. Clin Nutr ESPEN; 25:56-62.
- Hogan SE, Solomon MJ, Carey SK (2019). Exploring reasons behind patient compliance with nutrition supplements before pelvic exenteration surgery. Support Care Cancer; 27(5): 1853- 1860.
- Lidoriki I, et al. (2020). Oral Nutritional Supplementation Following Upper Gastrointestinal Cancer Surgery: A Prospective Analysis Exploring Potential Barriers to Compliance. J Am Coll Nutr.; doi: 10.1080/ 07315724.2020.1723453.
- Liljeberg E, et al. (2019). High Adherence to Oral Nutrition Supplements Prescribed by Dietitians: A Cross‐ Sectional Study on Hospital Outpatients. Nutr Clin Pract.; 34(6): 887-898
- Prescqipp. (2017). Guidelines for the appropriate prescribing of oral nutritional supplements (ONS) for adults in primary care. Accessed online: www.prescqipp.info/media/1512/b145-ons-guidelines-30.pdf (July 2021).
- Elia M, et al. Malnutrition Action Group. (2003). The ‘MUST’ Explanatory Booklet: A Guide to the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. BAPEN. Accessed online: www.bapen.org.uk/ pdfs/must/must_explan.pdf (July 2021).
- Malnutrition Pathway Consensus Panel. Managing Adult Malnutrition: Including a pathway for the appropriate use of oral nutritional supplements (ONS). Accessed www.malnutritionpathway.co.uk/ons (July 2021).
- Liljeberg E, et al. (2021). A qualitative exploration of dietitians’ experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support. J Hum Nutr Diet.; doi: 10.1111/jhn.12867 (Online ahead of print).
- Data on File - AYMES 2020