Jay M Mirtallo, Penny Allen, Wendy M Book, Kathryn Hennessy, Bettiemarie Bond, Beth Gore
{"title":"ASPEN 关于肠外营养获取问题的调查:系统如何辜负了患者。","authors":"Jay M Mirtallo, Penny Allen, Wendy M Book, Kathryn Hennessy, Bettiemarie Bond, Beth Gore","doi":"10.1002/ncp.11187","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Product shortages and a lack of qualified providers to manage care may impact the safety and efficacy of parenteral nutrition (PN). This survey assessed the frequency and extent to which limitations to PN-related access affects patients.</p><p><strong>Methods: </strong>Outpatient/patients receiving home PN were surveyed. Questions were developed to characterize the population and determine the extent and severity of PN access issues with components, devices, healthcare professionals, and transfers of care. Reimbursement issues surveyed included insurance coverage, contribution of healthcare costs to annual income, and the extent to which adjunctive therapy was reimbursed. Burdens surveyed included impact on disease symptoms and medical outcomes as well as the types and frequency of medical or system errors experienced, adverse events, or resultant nutrition problems.</p><p><strong>Results: </strong>Respondents (N = 170) were well educated, rented or owned their own home, and were either employed or retired. All age populations were represented. Patients made frequent contact with care providers. Most were able to manage PN costs but feared losing insurance or changes to insurance. Patients used additional prescribed therapies that are poorly covered by insurance. Patients reported symptoms or exacerbation of disease, development or worsening of malnutrition, and episodes of nutrient deficiency. Patients noted errors occur, especially during periods of transitions of care, when they also often encounter clinicians with little understanding of PN. These are high-acuity patients who have difficulty finding providers for their care.</p><p><strong>Conclusion: </strong>This patient survey provides evidence that access issues can result in the \"failure of the PN system\" to assure care is consistently safe and effective.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1164-1181"},"PeriodicalIF":2.1000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"ASPEN survey of parenteral nutrition access issues: How the system fails the patient.\",\"authors\":\"Jay M Mirtallo, Penny Allen, Wendy M Book, Kathryn Hennessy, Bettiemarie Bond, Beth Gore\",\"doi\":\"10.1002/ncp.11187\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Product shortages and a lack of qualified providers to manage care may impact the safety and efficacy of parenteral nutrition (PN). This survey assessed the frequency and extent to which limitations to PN-related access affects patients.</p><p><strong>Methods: </strong>Outpatient/patients receiving home PN were surveyed. Questions were developed to characterize the population and determine the extent and severity of PN access issues with components, devices, healthcare professionals, and transfers of care. Reimbursement issues surveyed included insurance coverage, contribution of healthcare costs to annual income, and the extent to which adjunctive therapy was reimbursed. Burdens surveyed included impact on disease symptoms and medical outcomes as well as the types and frequency of medical or system errors experienced, adverse events, or resultant nutrition problems.</p><p><strong>Results: </strong>Respondents (N = 170) were well educated, rented or owned their own home, and were either employed or retired. All age populations were represented. Patients made frequent contact with care providers. Most were able to manage PN costs but feared losing insurance or changes to insurance. Patients used additional prescribed therapies that are poorly covered by insurance. Patients reported symptoms or exacerbation of disease, development or worsening of malnutrition, and episodes of nutrient deficiency. Patients noted errors occur, especially during periods of transitions of care, when they also often encounter clinicians with little understanding of PN. These are high-acuity patients who have difficulty finding providers for their care.</p><p><strong>Conclusion: </strong>This patient survey provides evidence that access issues can result in the \\\"failure of the PN system\\\" to assure care is consistently safe and effective.</p>\",\"PeriodicalId\":19354,\"journal\":{\"name\":\"Nutrition in Clinical Practice\",\"volume\":\" \",\"pages\":\"1164-1181\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nutrition in Clinical Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ncp.11187\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nutrition in Clinical Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ncp.11187","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
ASPEN survey of parenteral nutrition access issues: How the system fails the patient.
Background: Product shortages and a lack of qualified providers to manage care may impact the safety and efficacy of parenteral nutrition (PN). This survey assessed the frequency and extent to which limitations to PN-related access affects patients.
Methods: Outpatient/patients receiving home PN were surveyed. Questions were developed to characterize the population and determine the extent and severity of PN access issues with components, devices, healthcare professionals, and transfers of care. Reimbursement issues surveyed included insurance coverage, contribution of healthcare costs to annual income, and the extent to which adjunctive therapy was reimbursed. Burdens surveyed included impact on disease symptoms and medical outcomes as well as the types and frequency of medical or system errors experienced, adverse events, or resultant nutrition problems.
Results: Respondents (N = 170) were well educated, rented or owned their own home, and were either employed or retired. All age populations were represented. Patients made frequent contact with care providers. Most were able to manage PN costs but feared losing insurance or changes to insurance. Patients used additional prescribed therapies that are poorly covered by insurance. Patients reported symptoms or exacerbation of disease, development or worsening of malnutrition, and episodes of nutrient deficiency. Patients noted errors occur, especially during periods of transitions of care, when they also often encounter clinicians with little understanding of PN. These are high-acuity patients who have difficulty finding providers for their care.
Conclusion: This patient survey provides evidence that access issues can result in the "failure of the PN system" to assure care is consistently safe and effective.
期刊介绍:
NCP is a peer-reviewed, interdisciplinary publication that publishes articles about the scientific basis and clinical application of nutrition and nutrition support. NCP contains comprehensive reviews, clinical research, case observations, and other types of papers written by experts in the field of nutrition and health care practitioners involved in the delivery of specialized nutrition support. This journal is a member of the Committee on Publication Ethics (COPE).