We started the Nutrition Support Team(NST) in 2005. Since our NST service had been limited to inpatient care, we conducted this study to determine whether we could also apply our NST service to outpatient care and to evaluate the efficacy of our NST service in the outpatient setting. The team was composed of three surgeons, two registered dietitians, one pharmacist and one technologist. In the outpatient setting, we found 21 malnourished patients with recent gastrointestinal surgery in the observed period. We provided the nutrition support to them on the same day when malnutrition was diagnosed. Nutrition support included dietary counseling and oral nutritional supplements if required. The nutritional status of the patients was assessed using subjective global assessment in addition to a number of anthropometric and biochemical parameters. The level of hemoglobin and serum levels of total protein, albumin and choline esterase after the intervention were significantly better than the initial data. There was no drop out during the observed period. These results suggest that our NST service is practicable in the outpatient setting and it may improve the nutritional status and outcome of malnourished patients with recent gastrointestinal surgery.

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To facilitate the implementation of home-visit-based nutritional support (home nutrition support) for in-home recipients of national insurance-covered nursing care services, efforts should be focused on raising the awareness of in-home care services among registered dietitians(nutritional care providers) as well as providing more information on the importance and role of home nutrition support to nursing care managers(who design and organize a personalized care plan for each care recipient) and physicians. Despite the fact that health care professionals of various related sections recognize it as effective intervention, home nutrition support has not frequently been implemented in actual practice settings. To clarify the reasons for the poor implementation of support, we conducted an online survey among 700 randomly selected nursing care managers from 11:00 on April 24 to 19:00 on May 8, 2008, and collected data from a total of 623(89.0%) respondents. The results showed that 554 nursing care managers had previously incorporated nutritional interventions into their nursing care plans for recipients with:(1) dysphagia,(2) problems in preparing therapeutic diets,(3) decubitus ulcers or impaired nutritional status due to reduced dietary intake, and(4) tube feeding such as percutaneous endoscopic gastrostomy(PEG) feeding, and that most of these required interventions were eligible for nursing insurance coverage when conducted as part of home nutrition support.

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