National Primary Care Collaboration Agreement on Malnutrition


The ‘National Primary Care Cooperation Agreement Undernutrition’ or in short ‘LESA’ has been developed by the NHG (general practitioners), V&VN (nursepractitioners) and NVD (dieticians). The agreement is designed to achieve better primary care for adults with or at risk of malnutrition by creating closer cooperation between GPs, nurses and dieticians. This requires tasks and responsibilities regarding detection, diagnosis, treatment and support to be divided. The goal is to have the most suitable care provider(s) provide the right care at the right time and to safeguard continuity of care for the patient.

GPs and nurses must remain vigilant for malnutrition in:

  • Vulnerable elderly patients at home, in care homes or in residential care.
  • Patients with multiple illnesses, chronic conditions or using multiple medications.
  • Patients with physical limitations.
  • Patients with poorly fitted dentures, difficulties with chewing or swallowing.
  • Patients (particularly older and seriously ill patients) recently discharged from the hospital.
  • Patients with psychosocial difficulties and neglect.
  • Patients with alcohol or drug abuse.

Care provider considerations
This agreement makes recommendations for cooperation and suggestions for working agreements between GPs, dietitians and nurses. The goal is to have most suitable care provider(s) provide the patient with the right care at the right time and to safeguard continuity of care. The care provider’s personal insights remain important, however. In certain concrete situations, well-argumented deviation from the LESA may be justified.

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