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One-third of patients in Polish hospitals are starving – the Polish Society of Parenteral and Enteral Nutrition is alerting.
Patients do not eat because they lose their appetite due to illness or medication. They also need to be fasting due to scheduled examinations. Sometimes, however, these move to the afternoon or the next day. As a consequence, the sick person gives up on the next meals. – Doctors do not ask patients if they have eaten breakfast or lunch. Nobody weighs the sick either. Everyone is satisfied and the patient is starving – says Stanisław Klęk, president of the Polish Society of Parenteral and Enteral Nutrition. In addition, hospital meals are often unappetizing, and their calorific value is based on improperly balanced ingredients. NIK revealed that in one of the hospitals inspected, dinners always consisted of bread, butter and tea only.
Some patients cannot eat because of their medical conditions, e.g. cancer of the esophagus. Others do not digest food. Meanwhile, the patients’ need for nutritional nutrients is greater, and adequate nutrition allows for faster recovery.
Enteral nutrition at home
28-year-old Marek Lichota, suffering from Crohn’s disease, says that he lost 30 kg during his month-long stay in the hospital. Due to the fact that he was malnourished, postoperative wounds healed poorly. – Purulent complications after surgery occur in 75% of malnourished patients and only 5% of those who are properly nourished – says Dr. Piotr Szubiński from the Polish Society of Parenteral and Enteral Nutrition. After leaving home, Marek struggled for five months to regain his normal weight. It was possible thanks to parenteral nutrition, i.e. intravenous administration of special mixtures containing nutrients.
The NHF finances parenteral nutrition, but hospitals rarely use it.
Norbert Świtoń, suffering from laryngeal cancer, lost several kilograms during his three-week stay in the hospital. He claims that if he had stayed in the ward longer, he would have been starved. At home, he started enteral nutrition, i.e. feeding food through a special tube that is placed in the nose, stomach or small intestine. He accepts special mixtures because – as he claims – he is not able to prepare meals mixed into mush.
Currently, the Home Nutrition Procedure financed by the National Health Fund covers 2065 patients, i.e. about 54 people per 1 million inhabitants. This is definitely not enough, which is why a large proportion of patients are waiting for the possibility of using this procedure. For example, in France, 250 people per 1 million inhabitants are fed enterally at home, and in Great Britain – 450.
Restrictions on the access to enteral nutrition at home and the financing of this nutrition in hospitals mean that the per capita consumption of enteral diets in Poland is one of the lowest in Europe.
Hospital diet
The regulations in force in Poland do not define nutritional standards in hospitals. Recommended are those established by the Food and Nutrition Institute in Warsaw, published in 2001 in the study “Scientific foundations of nutrition in hospitals”. The study shows that malnutrition of patients during hospitalization negatively affects the course of treatment and convalescence, causing the patient to stay longer in hospital and, consequently, to increase the costs of treatment. These costs can be up to 75% higher. The results of the Institute’s research indicate that the hospital diet does not meet the standards of nutrition for energy, minerals and most vitamins. In half of the patients, on discharge from the hospital, malnutrition appears or worsens, increasing the risk of complications and new diseases. In a report published at the end of 2009, the Supreme Chamber of Control negatively assessed nutrition in the controlled public hospitals. Both the quality of the meals and the manner of their preparation and distribution raised significant concerns. In every second inspected hospital, the caloric value of meals was based on improperly balanced ingredients. In all the menus were prepared in an unreliable way, as they did not provide the appropriate nutritional value of the meals and the proper proportion of vegetables and fruit. The diet also showed deficiencies in cereal and dairy products, the use of low-quality sausages, as well as overuse of salt. The quality and correctness of the preparation and distribution of meals were not controlled at all in five hospitals.
Nutritionist in the hospital
According to the information provided by the Supreme Audit Office, dieticians were not employed in 2 out of 12 audited hospitals, and in the remaining ones their effective operation was prevented by poor work organization. Nutritionists, instead of taking care of the proper quality of meals, often performed administrative or auxiliary activities. According to the Polish Dietetic Association in Krakow, the presence of dietitians is essential in the departments of internal, metabolic, endocrine, surgical and pediatric diseases. One dietitian should be in 30-40 hospitalized patients. – Meanwhile, in Poland there is one dietitian for 700 patients – says Stanisław Kłęk. The president of the Polish Dietetics Association, Danuta Gajewska, warns that dieticians are dismissed from work because hospitals are looking for savings in this way. – There is no legal regulation forcing hospital directors to employ dieticians. They are also not regular members of therapeutic teams. Doctors are not aware of the importance of proper nutrition of the patient. As a consequence, patients treated with very expensive non-standard chemotherapy die of hunger, says Gajewska.
Oral dietary preparations without refund
A sick person needs more energy and nutrients than a healthy one, and at the same time, due to the disease, he experiences problems with eating, therefore, properly introduced medical nutrition not only improves the patient’s well-being, but also supports the treatment and strengthens the fight against the disease. Oral nutrition is the simplest and least invasive way to provide the patient with the necessary nutrients during illness and recovery. Specialists recommend the administration of oral diet preparations. In Poland, not all patients receive them, because these products are not reimbursed by us. They are also not practically used as part of hospital treatment. The situation is different in the countries of Western Europe, where these preparations, referred to as FSMP – Food for Special Medical Purposes, have been reimbursed for a long time. In France, patients receive oral diets for full reimbursement in all diseases in the case of malnutrition. Oral diets are reimbursed in most European Union countries, including our neighbors – the Czech Republic and Hungary.