Chair: Anne de LooyGroup 1: Croatia and Poland

Croatian activities in Optimal Nutritional Care for All

CROATIAN MEDICAL ASSOCIATIONCROATIAN SOCIETY OF CLINICAL NUTRITION

1. Where are we today?

CROATIAN SOCIETY OF CLINICAL NUTRITION, CMA

1. Education activities

a)Incorporation of clinical nutrition in study curriculum of:

• School of Medicine

• School of Food and Technology- Nutritionists

• Nursing study

b)Different postgraduate courses (Medicine, Nutrition, Pharmacy)

c)Postgraduate Study of Nutrition (Medicine & Nutrition)

c) Local LLL courses in cooperation with local MNI

d) Congresses and Symposia

e) Adriatic Club of Clinical Nutrition (ACCN)

ACCN Initiative following Fight against malnutrition

Warsaw Declaration ACCN Declaration

CROATIAN SOCIETY OF CLINICAL NUTRITION, CMA

2. National Nutrition Guidelines

•Croatian Guidelines For Use Of Eicosapentaenoic Acid And Megestrol Acetate In Cancer Cancer

Cachexia Syndrome Cachexia Syndrome (2007)

•Croatian guidelines for use of enteral nutrition in Crohn's disease Crohn's disease (2010)

•Internal Guidelines at University Hospital Centre Zagreb (2011)

• Nutrition Guidelines for GERD and Gastritis, IBD, Hypertriglyceridemia and GERD and Gastritis, IBD, Hypertriglyceridemia and

HypercholesterolemiaHypercholesterolemia

•Croatian guidelines for treatment of diabetes mellitus type 2 diabetes mellitus type 2 (2011)

• Chapter: Guidelines for usage of enteral nutrition DM2

•Croatian guidelines for nutrition in the elderlyelderly (2011)

•Croatian guidelines for the management of pancreatic pancreatic

exocrine insufficiencyexocrine insufficiency (2012)

CROATIAN SOCIETY OF CLINICAL NUTRITION

3. Public Campaigns

Organization of public campaigns to raise awareness on proper nutrition and

malnutrition:

-Diet, Nutrition and IBD

-Nutrition Day

-Hospital Nutrition Days

CROATIAN SOCIETY OF CLINICAL NUTRITION

4. Nutrition Risk Screening Tool Implementation

•Fighting against malnutrition in Croatia – Study 2013 ESPEN

• gastroenterology departments of 9 hospitals in Croatia conducted a

multicentric study; NRS 2002 used to evaluate 1.786 patients

Projects in process:

•Implementation of NRS 2002 into Hospital information system – nutritional risk

screening to become obligatory

upon hospital admission

•Implementation of NRS 2002 in general practice

CROATIAN SOCIETY OF CLINICAL NUTRITION, CMA

5. Local Health Economic Studies•Cost of disease related malnutrition in Croatia – a hidden cost in the health care closet– 2012

•The economic burden of disease-related undernutrition in selected chronic diseases – 2013

Clinical Nutrition

•Economic impact of enteral and parenteral nutrition usage on

healthcare costs – 2015• collaboration of key stakeholders in order to obtain local data on cost of malnutrition and economic

impact of enteral and parenteral nutrition usage on healthcare costs

Optimal nutritional care for allWhere are we in Croatia?

Guidelines and standards

Education and training

Reimbursement

Implementation

Nutrition guidelines

National nutrition plan

Quality standards

Audit of quality standards

Other

Postgraduate nutrition training MDsScreening implementation nursesOther

Awareness programmes

Nutrition Day

Other

ONS

Tube

PN

Hospital Care home Community

Hospital Care home Community

Screen-ing

Care Plan

Other

Routine screening policyCommunity

Evidence

Economic benefits of nutritional care

Prevalence DRM

Cost of DRM

Other

StakeholdersMulti-stakeholder platform

Other

Industry group

PEN

Geriatric Soc

Patient associations

Hospital Care home

GoldGood

SilverMedium

BronzeLow

Don’t know?

What does success look like in 3-5 years?

• Country wide nutrition policy – obligatory nutritional screening /GP’s collecting professional credits by routine screening/

• Implementation of nutrition support in all hospitals, care homes and community

• Continous work on raising public awareness– Getting the right message to the right people

(patients,…,government)

What are the likely road blocks?

• Standardization of the best pratice screening tool, concordance with ICD-10

• Diagnose of malnutrition?• Lack of knowledge on clinical nutrition in

hospital settings• Lack of dietititians and specific competences• Focus of the industry• Cost-saving issues

What key steps that need to be taken to deliver success?

1. Obligatory nutritional screening & implementation of specific algorythms for nutritional support

2. Development of „Multi stakeholder platform”

3. Availability of support (in all settings)4. Public awareness