Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-27T01:20:53.456Z Has data issue: false hasContentIssue false
  • English
  • Français

Recent developments in the delivery of home parenteral nutrition in the UK

Published online by Cambridge University Press:  05 March 2007

Barry J. M. Jones
Barry J. M. Jones*
Affiliation:
Russells Hall Hospital, Dudley Group of Hospitals, NHS Trust, Dudley, DY1 2HQ, West Midlands, UK
*
*Corresponding author: Dr Barry J. M. Jones, fax +44 1384 244262, [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The British Artificial Nutrition Survey 2001 recorded 507 home parenteral nutrition (HPN) patients (Crohn's disease 31.5%, vascular disease 19.7%, cancer 6.9%). Parenteral nutrition was administered via tunnelled central line (92%) and supplied by a commercial homecare company in 89% of cases. The majority of HPN patients live at home (95.5%) with an independent life (74%), normal activity (59.2%) and 92% survive 1 year. However, there is good evidence that the geographical distribution of HPN patients is uneven (prevalence no patients to thirty-six patients per million of the population) suggesting inequity of access. Patients are increasingly concerned about the distances travelled to main centres and variable standards of more local support. Funding issues continue to cause difficulties as commissioning of health care transfers from Health Authorities to Primary Care Trusts. The two nationally-funded intestinal failure units provide HPN services to 220 HPN patients. HPN-related readmissions have displaced those awaiting admission for intestinal failure treatment, for which the waiting list mortality in one unit has risen to 14%. The government has now recognised HPN as a specialised service distinct from intestinal failure and that existing medium-sized HPN units should be encouraged to take on HPN patients from intestinal failure units and smaller units. In Scotland a Managed Clinical HPN Network supported by the Scottish administration now cares for seventy-two patients under common protocols. The challenge for the future is how to provide high-quality care to all who need it in the rest of the UK.

Keywords

Home parenteral nutritionIntestinal failure
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 3 , August 2003 , pp. 719 - 725
Copyright
Copyright © The Nutrition Society 2003

References

Baxter, JP, McKee, RF & Pennington, CR (2002) An accurate reflection of home parenteral nutrition in Scotland. Clinical Nutrition 21, Suppl. 1, P–271.Google Scholar
Baxter, JP & Tait, JM (2002) Scottish Home Parenteral Nutrition Managed Clinical Network: coordination and standards. Proceedings of the Nutrition Society 61, 359–361.CrossRefGoogle ScholarPubMed
British Association for Parenteral and Enteral Nutrition (1994) Home Parenteral Nutrition. Quality Criteria for Clinical Services and the Supply of Nutrient Fluids and Equipment. Redditch, Worcs.: Sovereign/BAPEN.Google Scholar
Department of Health (2002) Shifting the balance of power. http:doh.gov.uk/shiftingthebalance/.Google Scholar
Elia, M, Russell, C, Shaffer, J, Micklewright, A, Wood, S, Wheatley, C, Holden, C, Meadows, N, Thomas, A, Stratton, R & Scott, D (1999) Report of the British Artificial Nutrition Survey August 1999. Redditch, Worcs.: Sovereign/BAPEN.Google Scholar
Elia, M, Russell, CA, Stratton, RJ, Holden, CE, Micklewright, A, Barton, A, Wheatley, C, Meadows, NJ, Jones, BJ & Cooke, G (2001) Trends in Artificial Nutrition Support in the UK during 1996–2000. Redditch, Worcs.: Sovereign/BAPEN; summary available at www.bapen.org.uk/bans-es1996–2000.htmGoogle Scholar
Elia, M, Stratton, R & Russell, C (2002) Report of British Artificial Nutrition Survey 2001. Redditch, Worcs.: Sovereign/BAPEN.Google Scholar
Lennard-Jones, JE (1992) A Positive Approach to Nutrition as Treatment. London: King's Fund Centre.Google Scholar
London Regional Specialised Commissioning Group (2001) National Specialised Services Definition Set no. 12; Home Parenteral Nutrition. http://lrscg.lslha.nhs.uk/index.php.Google Scholar
McKee, RF, Baxter, JP & Pennington, CR (2002) An audit of the developing organisation of home parenteral nutrition (HPN) in Scotland. Clinical Nutrition 21, Suppl. 1, 0–28.Google Scholar
Ransford, R & Jones, BJ (2000) A thousand weeks of home parenteral nutrition at a District General Hospital in the UK. British Journal of Intensive Care 10, 150–154.Google Scholar
Scottish Executive (1998) Acute Services Review. Edinburgh: Scottish Executive.Google Scholar
Shaffer, J (2002) Intestinal failure: definition and service development. Clinical Nutrition 21, Suppl. 1, 144–145.CrossRefGoogle Scholar
Tait, J & Baxter, JP (2002) A managed clinical network for home parenteral nutrition. Nursing Times 98, 49–50.Google Scholar
Wheatley, C (2002) Ensuring Equity of Access and Quality of Care; Patients' Perspectives and Results of National Survey. Christchurch, Dorset: PINNT.Google Scholar