Home parenteral nutrition: An international benchmarking exercise

Background & aims: Information relating to the provision of HPN in New Zealand and Scotland has been published. ¹ This paper expands that benchmarking exercise to examine the organisation, prevalence and referral pathways across several countries of the world. Methods: The ESPEN Home Artificial Nutrition Chronic Intestinal Failure working group agreed a pro forma and circulated a network of international colleagues. Results: Responses were received from 16 countries treating an estimated 9200 patients. Period prevalence figures ranged from 3.25 to 66 patients per million of the population. Eight countries (53%) had published HPN guidelines; of the 7 who did not, 4 (27%) had adopted guidelines such as ESPEN. Eleven (73%) had an HPN educational programme in place. The most common underlying disease for HPN in adults were ischaemia, Crohns' disease, motility disorders and cancer; and in children enteropathy, motility and inflammatory bowel disease (unknown in 4 countries). Conclusions: There is a wide range in HPN prevalence figures and the existence of organised care varies across the countries studied. Most countries either had developed their own clinical guidelines or standards or had adopted an international society guideline to improve patient care. It is recognised that several countries have under reported the HPN prevalence as registries are not fully available or used. This comparative data is interesting to enable the planning of equitable care.