ONCA Conference Copenhagen Creating Equality in Nutritional Care

Estrategy for the management of malnutrition in the complex chronic patient in Catalunya

Catalunya starts an estrategy for the detection and treatment of malnutrition in patients with complex chronic diseases in the Community.


“Malnutrition has a negative impact in the clinical outcome and even in the prognosis of many pathologies that conform the complexity”

Rosa Burgos

“Nowadays we are focussing our practice in those patients with complex needs in health. Our goal is to achieve an optimal nutritional status in the mid-term”

Carles Blay


The prevalence of malnutrition in patients with complex chronic diseases is unknown. We can expect that the prevalence is higher than in the general population and in those patients suffering only one chronic disease, and this is one of the objectives of this programme.

The mission of the programme is to improve the treatment of these patients, approaching both health and social aspects, maintaining the principles of quality and sustainability, while paying attention also to the caregivers and families.

The key elements of the Plan are:

  • Person- centred attention
  • Poblational focus
  • Prevention and promotion of healthly lifestyles
  • Promotion of self-responsability and self-care
  • Support the caregivers
  • Social and health approach
  • Focus on complex health and social needs
  • Maintain the sustainability of the Health System and social welfare.




The Plan has been developed in close collaboration with the Programme of Chronicity Attention and the Interdepartment Programme of Social and Heath Attention, with the support of the Spanish Society for Parenteral and Enteral Nutrition (SENPE) and with the implication of the Family and Community Nursing. The Plan is centred in the Community as this is the main place in which patients with complex and chronic diseases should be managed.

The Plan includes the early detection of malnutrition by means of nutritional screening and social risk screening, linked to algorythms to establish an action plan.

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