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Are complications in home parenteral nutrition related to frequency of patient review?

Published online by Cambridge University Press:  23 July 2009

N. S. Hallum ,
J. P. Baxter  and
R. F. Mckee
N. S. Hallum
Affiliation:
Department of Surgery, Glasgow Royal Infirmary, GlasgowG31 2ER, UK
J. P. Baxter
Affiliation:
Scottish Home Parenteral Nutrition Managed Clinical Network, Ninewells Hospital and Medical School, DundeeDD1 9SY, UK
R. F. Mckee
Affiliation:
Department of Surgery, Glasgow Royal Infirmary, GlasgowG31 2ER, UK
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Abstract

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Proceedings of the Nutrition Society , Volume 68 , Issue OCE1: OCE Malnutrition Matters, Joint BAPEN and Nutrition Society, 4–5 November 2008, Harrogate , 2009 , E14
Copyright
Copyright © The Authors 2009

A previous study reported on the frequency and adequacy of monitoring of patients on home parenteral nutrition (HPN) in Scotland (NS Hallum, JP Baxter and RF McKee, unpublished results). Of fifty-three patients receiving HPN during 2006, one-third were always seen within the 100 d guideline set by the Scottish HPN Managed Clinical Network (MCN). Two-thirds of patients did not always meet the guideline but eighteen of these met it intermittently. The present study considers whether patients who received less-frequent supervision had more HPN-related complications than those who were reviewed more often and always met the 100 d target.

Data have been collected prospectively on all patients having HPN in Scotland by the MCN since 2000. The 2006 data were extracted.

There is no significant difference between numbers of patients with complications in the three review-frequency groups. The results of this study do not support an association between review interval and complication rates. The MCN guideline of multiprofessional three-monthly reviews for all patients having HPN is based on expert opinion rather than higher levels of evidence. The present study indicates that less-frequent review does not necessarily equate with higher rates of complication; therefore, longer intervals between clinic visits might be clinically and economically justified. Is a two-tier system of review appropriate, whereby all patients are seen regularly but new or complex patients are seen more often?