2023-05-03 15:13:19
Medical professor Philipp Schütz on ignorance in clinics and politics – and what Germany can learn from Switzerland. An interview by Martin Rücker
Professor Schütz, with your research you were able to prove that nutritional therapy can save lives in hospitals. Why hasn’t it been standard for a long time?
The main point is ignorance, in clinic management and in politics. We spend a lot of money on drugs that are much more expensive and much less efficient. Nutritional therapy, on the other hand, has long been pushed into the wrong corner. In medicine it had a reputation like homeopathy that it probably doesn’t do much. Good clinical studies were missing for a long time. But that has changed: we have evidence that dietary measures in hospital reduce mortality and that patients also benefit in terms of quality of life and functionality. Since then, the skepticism of the medical profession has decreased, and the clinics are dealing with it. However, some educational work is still needed. We could avoid many deaths.
Some hospital officials doubt that dietary changes will make as much difference in the few days spent in the hospital.
This has been clearly proven empirically. In our study, we achieved great effects in just ten days. It is important to carry out a screening for malnutrition as soon as you are admitted to the hospital so that we do not lose any time. Whether sick people eat 200 kilocalories and 30 grams of protein more or less every day, it adds up. In addition, the rehospitalization rate decreases if we also advise the patients for the time after their discharge. Nutritional therapy is therefore worthwhile in every respect. The problem is that many clinics are underfunded. It is therefore not the best time to start new programs.
Speaking of nutritional therapy, what changes would be most important?
Firstly, patient screening to detect malnutrition at an early stage. An individually tailored therapy plan must then be drawn up for those affected by the team of nutritionists and the hospital kitchen. The problems are very different: some have difficulty swallowing, others have diabetes or thyroid disease, or they simply don’t have an appetite because of their illness. The catering must also be adjusted accordingly. Also, food is something very personal. It is therefore important to involve patients. This is the only way we can give them something to take with them after they are discharged from the clinic.
Has your research in Switzerland led to improvements?
We see clear progress. Malnutrition management in the clinic is now included in the quality contract between the clinics and the Federal Office of Public Health. We are in the process of defining specific criteria with the umbrella organization of hospitals. For example, clinics will need to screen at least 90 percent of their patients for malnutrition and then provide them with nutritional advice. If they do not meet the requirements of the quality contract, financial deductions are due. This will further increase the interest of the clinics. We already have slightly better conditions in Switzerland than in Germany, because the dietary therapy is better remunerated in the flat-rate per case. That is why there are interdisciplinary nutrition teams in almost all larger clinics that take care of the patients.
Many tumor patients, but also people with diabetes or obesity, do not receive any nutritional therapy in Germany. Would something have to change on an outpatient basis as well?
It would be extremely important for the patients that nutritional advice would be paid for by health insurance companies. In healthcare policy there is always the fear of cost increases. For nutritional therapy in the clinic, we were able to show that it not only helps the patient, but is also very cost-effective. I think that we can also reduce mortality with outpatient nutritional advice and also save costs because later treatment without this prevention is more expensive. We are currently testing this thesis with a new study, the “EFFORT II” experiment.
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