Adequacy of financing and prescription of home enteral nutrition. Are things being done right?

Abstract

Introduction: this study focuses on Home Enteral Nutrition (HEN), whose use has grown enormously in recent years.

Objective: to analyze the prescriptions and, in addition, determine whether National Health System (NHS) funding criteria are met and to explore whether overcosts exist.

Methods: a retrospective observational study was conducted on 844 patients (895 episodes) who received HEN, using information obtained from the healthcare database. Demographic, clinical, dietary, and economic data were analyzed.

Results: in 9.7 % of the episodes analyzed, the funding criteria were met; in 15.1 %, ≥ 50 % kcal/day required was provided through HEN. During the 3 months of the study an average of 118.1 ± 86.8 units/patient were dispensed, which resulted in an average monthly expenditure of € 69.9 ± 66.3/patient. To go to the hospital to collect HEN, an average of 78.1 ± 69.5 km/patient was traveled, with an associated average monthly fuel cost of € 2.65 ± 2.39/patient. The additional expenditure associated with prescriptions not aligned with the funding criteria was estimated at € 574,259.44/year in the health area analyzed, with a quota of 200,000 inhabitants.

Conclusions: the results of this study show a divergence in the use of HEN compared to the conditions established by the NHS for the funding of this treatment. Given the low compliance rate and the current scientific evidence on the use of HEN, it may be necessary to re-evaluate the funding criteria to make them more representative of clinical evidence and actual practice.