Global Nutrition Home Care Survey

Introduction:

The use of home nutrition support has become more common globally due to advances in technology, development of portable equipment, improved tubes and catheters, communication options and awareness of a better recovery at home than in hospitals.

Studies have shown in different countries that the population of patients receiving ether home enteral or parenteral nutrition at home is increasing. Then years ago, in a review paper that provided an international perspective of home enteral nutrition, the author described that in the UK, there was an increase of 42.78% of patients receiving HEN in the previous 10 years, while in China, patients with HEN had shorter hospital stays than those who did not were able to use home care. In this review the authors described the complications and challenges that professionals experience in different countries in providing HEN 1.

As for home parenteral nutrition, there is a recent publication describing the survival rate in patients with neuroendocrine tumors treated with HTPN.  The authors reported  that TPN can be used safely in patients with neuroendocrine tumors as well as in intestinal failure to increase survival beyond that reasonably expected in the context of either short bowel syndrome or inoperable malignant bowel obstruction 2.

Policies have been developed around this topic in European Countries. In a paper that compared the legislation policies regarding home artificial nutrition (HAN), the authors concluded that despite different policies existing in some European counties, funding is relatively uniform, and national health systems support most of the expenses for home nutritional care 3. However, this is certainly not the case of the rest of the world.

A survey was perforned in the Asia Pacific region to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs), and clinical nutrition education in this region. The authors found that this is totally different in high and middle-upper income countries that use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diets. The presence of NST that manage home care was limited and only present mainly in acute care settings, but not in home care settings. The survey showed that only sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrated that there is a very different clinical and economic situation in the Asia Pacific region. They also showed that there is a lack of reimbursement, clinical support educational opportunities, especially for the lower-middle income countries 4.

This project aims to provide an overview of global availability  of Nutrition Home Care (NHC) and idenify some of the challenges experienced as well and possibly generate ideas abouthow to solve this both in developing and developed countries.

We have designed this questionnaire to gather information about the current practices and challenges experienced in Home Care Nutrition practices in different counties with different income status from around the world.

You might want to add something about how you will identify respondents to the questionnaires and why your target audience is suitable to for this task.

REFERENCES:

2. 1)   Ojo O. (2015). The challenges of home enteral tube feeding: a global perspective. Nutrients, 7(4), 2524–2538. https://doi.org/10.3390/nu7042524
3.  
4. 2)   Clement, D. S. V. M., Srirajaskanthan, R., Ramage, J. K., Tesselaar, M. E. T., Khan, M. S., Verbeek, W. H. M., Wanten, G. J. A., & Naghibi, M. (2023). Outcomes and survival in patients with advanced intestinal neuroendocrine tumours on home parenteral nutrition, an international multicentre retrospective cohort study. Clinical nutrition ESPEN, 54, 106–112. https://doi.org/10.1016/j.clnesp.2023.01.008
6. 3)     Moreno , J. M., Shaffer , J., Staun , M., Hebuterne , X., Bozzetti , F., Pertkiewicz , M., Thul , P., Van Gossum, A., & Home Artificial Nutrition Working Group–ESPEN (2001). Survey on legislation and funding of home artificial nutrition in different European countries. Clinical nutrition (Edinburgh, Scotland), 20(2), 117–123. https://doi.org/10.1054/clnu.2000.0363
8. 4)     Wong, A., Banks, M. D., & Bauer, J. D. (2018). A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region. Nutrients, 10(2), 214. https://doi.org/10.3390/nu10020214