Flood Caroline, Parker Elizabeth Kumiko, Kaul Neha, Deftereos Irene, Breik Lina, Asrani Varsha, Talbot Peter, Burgell Rebecca, Nyulasi Ibolya
Nutrition Department, Alfred Health, Melbourne, Victoria, Australia.
Department of Dietetics and Nutrition, Westmead Hospital, Sydney, New South Wales, Australia.
Clin Nutr ESPEN. 2021 Aug;44:387-396. doi: 10.1016/j.clnesp.2021.05.007. Epub 2021 May 26.
BACKGROUND & AIMS: Patients receiving home enteral nutrition (HEN) via an enteral feeding tube often have complex healthcare requirements. There is limited information regarding how HEN care is provided within Australia and New Zealand. This study aimed to investigate the characteristics of HEN services and the provision of nutrition care to individuals receiving HEN within Australia and New Zealand.
A cross-sectional study, surveying lead HEN dietitians for HEN services was conducted from the period 09 July 2019 to 20 September 2019 inclusive. An online survey was used to obtain data relating to the demographics, funding and clinical resources of respondents' HEN services. Services were benchmarked against a HEN service implementation checklist adapted from the Agency for Clinical Innovation (ACI).
Responses were received from 107 HEN services, with an estimated combined population of 7122 HEN patients. Services were predominantly government-funded (n = 102, 95.3%) and operated from acute hospitals (n = 57, 53.3%). The reported combined cost of all HEN equipment to the patient ranged from $0-$77 per week or $0-$341 per month. Fifty-two services were reported to have a dedicated HEN dietitian/coordinator, which was positively associated with the undertaking of quality improvement activities (p = 0.019). Mean compliance to the ACI HEN implementation checklist was 70.4% (±15.7%) with a range of 13.0-98.2%. Mean compliance was significantly higher in services with a HEN dietitian/coordinator than services without one (75.5% (±12.0%) vs 64.3% (±16.6%); p < 0.001).
This study provides detailed information regarding the characteristics of HEN services and nutrition care provided to enterally-fed patients across Australia and New Zealand. The majority of HEN services are not adhering to the ACI HEN service guidelines and there is considerable variation in cost burden for consumers indicating inequitable delivery of care to patients.
通过肠内喂养管接受家庭肠内营养（HEN）的患者通常有复杂的医疗保健需求。关于澳大利亚和新西兰如何提供HEN护理的信息有限。本研究旨在调查澳大利亚和新西兰HEN服务的特点以及为接受HEN的个体提供营养护理的情况。
2019年7月9日至2019年9月20日（含）期间进行了一项横断面研究，对HEN服务的主要营养师进行调查。采用在线调查获取与受访者HEN服务的人口统计学、资金和临床资源相关的数据。根据临床创新局（ACI）改编的HEN服务实施清单对服务进行基准评估。
收到了107项HEN服务的回复，估计HEN患者总数为7122人。服务主要由政府资助（n = 102，95.3%），并在急症医院开展（n = 57，53.3%）。据报告，所有HEN设备给患者带来的每周综合成本为0至77美元，或每月0至341美元。据报告，有52项服务设有专门的HEN营养师/协调员，这与开展质量改进活动呈正相关（p = 0.019）。对ACI HEN实施清单的平均依从率为70.4%（±15.7%），范围为13.0%至98.2%。有HEN营养师/协调员的服务的平均依从率显著高于没有的服务（75.5%（±12.0%）对64.3%（±16.6%）；p < 0.001）。
本研究提供了有关澳大利亚和新西兰为肠内喂养患者提供的HEN服务和营养护理特点的详细信息。大多数HEN服务未遵循ACI HEN服务指南，消费者的成本负担存在很大差异，表明对患者的护理提供不公平。
