TY - JOUR
T1 - Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey
AU - The Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN
AU - The European Society for Clinical Nutrition and Metabolism
AU - Pironi, Loris
AU - Steiger, Ezra
AU - Brandt, Chrisoffer
AU - Joly, Francisca
AU - Wanten, Geert
AU - Chambrier, Cecile
AU - Aimasso, Umberto
AU - Sasdelli, Anna Simona
AU - Zeraschi, Sarah
AU - Kelly, Darlene
AU - Szczepanek, Kinga
AU - Jukes, Amelia
AU - di Caro, Simona
AU - Theilla, Miriam
AU - Kunecki, Marek
AU - Daniels, Joanne
AU - Serlie, Mireille
AU - Poullenot, Florian
AU - Wu, Jian
AU - Cooper, Sheldon C.
AU - Rasmussen, Henrik H.
AU - Compher, Charlene
AU - Seguy, David
AU - Crivelli, Adriana
AU - Pagano, Maria C.
AU - Hughes, Sarah-Jane
AU - Guglielmi, Francesco W.
AU - Kozjek, Nada Rotovnik
AU - Schneider, Stéphane M.
AU - Gillanders, Lyn
AU - Ellegard, Lars
AU - Thibault, Ronan
AU - Matras, Przemysław
AU - Zmarzly, Anna
AU - Matysiak, Konrad
AU - van Gossum, Andrè
AU - Forbes, Alastair
AU - Wyer, Nicola
AU - Taus, Marina
AU - Virgili, Nuria M.
AU - O'Callaghan, Margie
AU - Chapman, Brooke
AU - Osland, Emma
AU - Cuerda, Cristina
AU - Sahin, Peter
AU - Jones, Lynn
AU - Won Lee, Andre Dong
AU - Masconale, Luisa
AU - Orlandoni, Paolo
AU - Izbéki, Ferenc
PY - 2020/2
Y1 - 2020/2
N2 - Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
AB - Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
KW - Cancer
KW - Home parenteral nutrition
KW - Intestinal failure
KW - Intravenous supplementation
UR - http://www.scopus.com/inward/record.url?scp=85064135500&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.clnu.2019.03.010
DO - https://doi.org/10.1016/j.clnu.2019.03.010
M3 - Article
C2 - 30992207
SN - 0261-5614
VL - 39
SP - 585
EP - 591
JO - Clinical nutrition (Edinburgh, Scotland)
JF - Clinical nutrition (Edinburgh, Scotland)
IS - 2
ER -