Funding and resource availability for home parenteral nutrition in Australia: A national cross-sectional survey

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition Pub Date : 2024-06-08 DOI:10.1002/jpen.2656

Darren Wong MBBS, PhD, Emma Osland MPhil, Sharon Carey PhD

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Abstract

Background

Home parenteral nutrition (HPN) is a life-saving therapy required for the management of type III intestinal failure, one of the rarest organ failures. It requires a multidisciplinary approach to manage the complexity of the underlying medical, surgical, and nutrition issues, but the current levels of healthcare funding in Australia are unknown. This study aimed to quantify the caseload, staffing, and capacity of existing HPN centers nationally.

Methods

This was a cross-sectional survey inviting centers known to provide HPN care. The survey was designed to capture metrics related to the national framework for the delivery of HPN. These centered on staffing levels, patient load, capacity to audit key outcomes, and service challenges.

Results

A total of 24 (89%) of 27 invited centers responded to the survey. There were 17 (71%) adult centers and 7 (29%) pediatric centers. Adult centers managed a median of 12 (interquartile range [IQR]: 6–25) patients vs 16 (IQR: 9–17) in pediatric centers. Several centers did not have dedicated funding for core team members. The total funded clinician time each week per patient was 7 min (IQR: 0–12 min) in adult centers and 14 min (IQR: 10–21 min) in pediatric centers. Fewer than half of centers reported having sufficient resources to regularly audit key metrics.

Conclusion

The availability of dedicated expertise to manage the highly complex needs of people living with type III intestinal failure is lacking in Australia. Current funding of HPN services falls well short of being sufficient to meet the requirements outlined in the national quality framework.

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澳大利亚家庭肠外营养的资金和资源可用性：全国横断面调查。

背景：家庭肠外营养（HPN）是治疗 III 型肠道功能衰竭（最罕见的器官功能衰竭之一）所需的一种挽救生命的疗法。它需要多学科方法来处理复杂的内科、外科和营养问题，但澳大利亚目前的医疗保健资金水平尚不清楚。本研究旨在量化全国现有 HPN 中心的工作量、人员配备和能力：这是一项横向调查，邀请已知可提供 HPN 护理的中心参与。调查旨在获取与提供 HPN 的国家框架相关的指标。这些指标主要集中在人员配备水平、病人数量、审核关键结果的能力以及服务挑战等方面：在 27 家受邀中心中，共有 24 家（89%）对调查做出了回应。其中成人中心 17 家（占 71%），儿科中心 7 家（占 29%）。成人中心管理的患者中位数为 12 人（四分位间距 [IQR]：6-25），儿科中心为 16 人（四分位间距 [IQR]：9-17）。一些中心没有为核心团队成员提供专项资金。在成人中心，临床医生每周为每位患者投入的总时间为 7 分钟（IQR：0-12 分钟），在儿科中心为 14 分钟（IQR：10-21 分钟）。只有不到一半的中心表示拥有足够的资源来定期审核关键指标：结论：澳大利亚缺乏管理 III 型肠道功能衰竭患者高度复杂需求的专业人才。目前对 HPN 服务的资助远远不足以满足国家质量框架中列出的要求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Parenteral and Enteral Nutrition 医学-营养学

CiteScore

7.80

自引率

8.80%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or IV therapies. Also included: reviews, techniques, brief reports, case reports, and abstracts.