Home care and primary care: introduction / facts

Home care and primary care

In Dutch home care patients, the prevalence of malnutrition is estimated to range between 17 and 35%. A recent study has shown a prevalence of 12% among patients visiting general practices (during the influenza vaccination) and 11% in a population based sample. The prevalence significantly increased with age. Unfortunately, nutritional status is only assessed in 16% of the home care patients and in only 5% a validated screening instrument is used.

Home care project

The Dutch Malnutrition Steering Group started a three-year's project in 2008 to improve screening and treatment of malnutrition in primary care and home care. This project consists of different phases:

1. Development of a screening instrument for quick and easy screening of malnutrition in community-dwelling older individuals: the Short Nutritional Assessment Questionnaire 65+ (SNAQ⁶⁵⁺⁾

2. Development of a toolkit, consisting of:

• The SNAQ⁶⁵⁺
• A multidisciplinary treatment protocol
• Workbook for use in the treatment
• Free half fabricates (presentations, newsletter, patient brochures with information)
• Project plan
• Best practices and tools which can be used for the implementation
• Factsheets and literature

3. Development of the ‘National Primary Care Cooperation Agreement Undernutrition’ by three Dutch organizations: the Dutch College of General Practitioners (NHG), Netherlands association for nursing and care (V&VN) and the Dutch Association for Dietitians (NVD).

4. Implementation of the toolkit at several locations in the Netherlands through providing training programs and workshops for dietitians.

5. An intervention study to investigate the (cost) effectiveness of a dietary treatment in undernourished older people (65+) living at home after screening in primary care and home care. The SNAQ⁶⁵⁺ is used for assessing undernutrition. Primary outcomes are weight change and quality of life. Several other factors are measured, for example physical functioning, functional limitations, anthropometric factors, and health care costs. Examinations for the study take place at baseline, after 3 months and after 6 months.