Organisation, niveaux de prise en charge de la dénutrition et place des acteurs de santé dans les parcours de soins en nutrition à l'hôpital et en ville

This paper describes the role of actors in the coordinated healthcare circuit in hospital and ambulatory. At the hospital, the respective roles of each intervener depend on their organization. The transversal organization and the creation of dietetics-nutrition unit could improve the efficiency of the management. This organization sets the level of intervention of each professional involved. Dieticians and nutritionists are central to the management but teaching in adapted physical activity must find its place in the coordinated healthcare circuit of malnourished patients in the hospital and in ambulatory. The role of liberal nutritionist currently very limited has to be discussed. Finally, the general practitioner has a central role in the coordinated healthcare circuit and should have access to coordination platforms allowing patients to access to dieticians and to teachers in adapted physical activity, currently unsupported. This article largely repeats the teaching synthesis on coordinated healthcare circuit in health facilities, incorporates proposals made by the French Society of Clinical Nutrition and Metabolism (SFNEP) for actions in the “Plan National Nutrition Santé” 2011-2015 and proposes changes in the organization in the coordinated healthcare circuit and in the role of actors.