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Home enteral tube feeding in East Anglia
Objective:
To establish the profile of patients receiving home enteral tube feeding (HETF) in East Anglia, to assess the adequacy of care, and to consider the causes and implications of differences in the geographic prevalence of HETF.
Design:
A 1-year prospective study.
Setting:
Eight independently funded districts within East Anglia.
Subjects:
Basic clinical data were available from 234 patients, 191 of which were tube-fed in the same district as that which initiated treatment, with detailed data obtained from 126.
Outcome Measures:
Prevalence, complications in relation to the dietetic support available, and standards of care in relation to those set in the reports of the King's Fund and the British Association of Parenteral and Enteral Nutrition.
Results:
The patients, who were usually elderly subjects or children, had severe disabilities: 40% were unable to walk: 39% were unable to speak; and 20% were housebound. In all cases enteral tube feeding had been initiated in hospital but in this survey we found inadequate training for home care in 23%, inadequate support and follow-up in 20%, inadequate equipment in 41%, uncertainties regarding organisation, and various clinical problems such as feed regurgitation, in 22%, aspiration pneumonia in 13% , which occasionally led to hospitalization (4%), and frequent but usually minor peristomal problems in patients with gastrostomies. There was a direct correlation between the prevalence of HETF (which varied fourfold between districts) and the number of NHS dieticians per head of population; and in inverse correlation with respect to requests by patients for more support (r = 0.97), complaints of blocked tubes (r = 0.82) and the need for hospital help.
Conclusion:
HETF provides an important form of support to a small group of severely disabled patients. There are important differences between districts in the prevalence of HETF which may be related to variation in local expertise and available support staff. The standards of care did not always conform to those set in the King's Fund report and BAPEN report on Enteral and Parenteral Nutrition in the community.