Pharmacist involvement in home parenteral nutrition programs.

Area of Science:

• Clinical Nutrition
• Health Services Research
• Pharmacy Practice

Background:

• Home parenteral nutrition (HPN) is a critical therapy for patients with intestinal failure.
• Understanding the operational characteristics of HPN programs is essential for optimizing patient care and resource allocation.

Purpose of the Study:

• To characterize the landscape of hospital-based home parenteral nutrition (HPN) programs in the United States.
• To identify key operational aspects, including program structure, patient volume, solution preparation, and reimbursement models.

Main Methods:

• A national survey was conducted targeting hospitals believed to have HPN programs.
• Questionnaires were mailed to 70 hospitals, achieving a 90% response rate.
• Usable data from 51 (73%) programs were analyzed to describe typical program characteristics.

Main Results:

• The typical HPN program is situated in a large, private, nonprofit, university-affiliated teaching hospital.
• Programs had been operational for a mean of three years, serving a small patient volume (≤2 patients).
• Hospital pharmacies prepared nutrition solutions in 57% of cases; 25% prepared them at home. Patient education was common, with pharmacists and physicians monitoring labs. Reimbursement for solutions/supplies was high (90%), but for education was lower (20%).

Conclusions:

• Hospital-based HPN programs are predominantly found in larger academic medical centers.
• Operational models vary, particularly in solution preparation, highlighting a need for standardized practices.
• While reimbursement for HPN services is widespread, coverage for crucial patient education components remains limited.