Survey on legislation and funding of home artificial nutrition in different European countries.
BACKGROUND
Home Artificial Nutrition (HAN) has been an expanding area over the last 30 years. HAN programs have been often developed prior to the regulation by the National Health Systems (NHS) leading to different policies within European countries. The aim of this study was to compare legislation regarding HAN in Europe.


METHODS
The Group elaborated two structured questionnaires (one for Home Enteral Nutrition--HEN--and one for Home Parenteral Nutrition--HPN) which were presented to all the members of the HAN-Working group and to the 21 ESPEN Council members.


RESULTS
Twelve questionnaires were returned, covering for more than 375 million inhabitants. HEN: regulated in seven countries, Italy and France being the first to implement reimbursement policy in 1988. Except in France, Croatia and the Czech Rep almost any physician can prescribe HEN. NHS totally or partially fund HEN, although in Austria and Israel expenses are paid for the patients. Provision of enteral diets and equipment varies widely within countries. As in HPN, most of the countries have written guidelines for health care workers and for patients. HPN: legislated in six countries, Denmark being the first in 1975. HPN programs are restricted to a few hospitals and patients are followed by Nutrition Support Teams (NST). The budget for HPN is 100% supported by NHS. Hospital pharmacy, private pharmacists and Home Care companies are involved in a different degree in providing and distributing solutions and disposables.


CONCLUSIONS
HPN regulation preceded HEN regulation by 10-20 years. Due to this longer experience and high level of care, HPN patients are usually followed by NST. Despite different policies, funding is relatively uniform, NHS supporting most of the expenses for HAN. ESPEN could play a key role developing common standards for HAN all over Europe.
Moreno
J M
JM
Department of Paediatrics, Hospital 12 de Octubre, Madrid, Spain.
Shaffer
J
J
Staun
M
M
Hebuterne
X
X
Bozzetti
F
F
Pertkiewicz
M
M
Thul
P
P
Van Gossum
A
A
D004750:Enteral Nutrition / Q000191:economics; D005060:Europe; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006699:Home Care Services / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D018673:Nutrition Policy / Q000331:legislation & jurisprudence*; D018529:Nutritional Support / Q000191:economics*; D016331:Parenteral Nutrition, Home / Q000191:economics*; D011795:Surveys and Questionnaires