Chair: Anne de Looy Group 1: Croatia and Poland Croatian activities in Optimal Nutritional Care for All C ROATIAN M EDICAL A SSOCIATION C ROATIAN S OCIETY OF C LINICAL N UTRITION

1. Where are we today?

C ROATIAN S OCIETY OF C LINICAL N UTRITION, 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

C ROATIAN S OCIETY OF C LINICAL N UTRITION, CMA 2. National Nutrition Guidelines Cancer Cachexia Syndrome Croatian Guidelines For Use Of Eicosapentaenoic Acid And Megestrol Acetate In Cancer Cachexia Syndrome (2007) Crohn's disease Croatian guidelines for use of enteral nutrition in Crohn's disease (2010) Internal Guidelines at University Hospital Centre Zagreb (2011) GERD and Gastritis, IBD, Hypertriglyceridemia and Hypercholesterolemia Nutrition Guidelines for GERD and Gastritis, IBD, Hypertriglyceridemia and Hypercholesterolemia diabetes mellitus type 2 Croatian guidelines for treatment of diabetes mellitus type 2 (2011) Chapter: Guidelines for usage of enteral nutrition DM2 elderly Croatian guidelines for nutrition in the elderly (2011) pancreatic Croatian guidelines for the management of pancreatic exocrine insufficiency exocrine insufficiency (2012)

C ROATIAN S OCIETY OF C LINICAL N UTRITION 3. Public Campaigns Organization of public campaigns to raise awareness on proper nutrition and malnutrition: -Diet, Nutrition and IBD -Nutrition Day -Hospital Nutrition Days

C ROATIAN S OCIETY OF C LINICAL N UTRITION 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 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

C ROATIAN S OCIETY OF C LINICAL N UTRITION, 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 all Where 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 MDs Screening implementation nurses Other Awareness programmes Nutrition Day Other ONS Tube PN Hospital Care home Community Screen- ing Care Plan Other Routine screening policy Community Evidence Economic benefits of nutritional care Prevalence DRM Cost of DRM Other Stakeholders Multi-stakeholder platform Other Industry group PEN Geriatric Soc Patient associations Hospital Care home Gold Good Silver Medium Bronze Low 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