Home parenteral nutrition: does affiliation with a national support and educational organization improve patient outcomes?
BACKGROUND
For patients receiving home parenteral nutrition (HPN), catheter-related bloodstream infection (CRBSI) and reactive depression may significantly impact quality-of-life. This study evaluated the influence of patient affiliation with a national organization promoting HPN education and peer support on these outcome variables.


METHODS
Using a case-control design, we compared 2 groups of affiliated patients with nonaffiliated controls, who were matched for diagnosis, HPN duration, sex, and age. Group 1 data were obtained from patients in large HPN medical practice programs. Group 2 data were obtained from patients in small medical practices with a small number of HPN patients. All participants were evaluated by structured interviews every 6 months over 18 months.


RESULTS
In both data collection groups, affiliated patients (A) had significantly higher (mean +/- SD) quality-of-life scores compared with nonaffiliated patients (NA): (Gr 1: A, 19.8 +/- 4.7 versus NA, 17.6 +/- 5.6, p = .05; Gr 2: A, 20.4 +/- 5.2 versus NA, 17.3 +/- 4.8, p = .05). Affiliated patients also had lower depression scores (Gr 1: A, 10.9 +/- 10.4 versus NA, 20.4 +/- 13.6, p = .01; Gr 2: A, 12.5 +/- 9.6 versus NA, 18.5 +/- 10.8, p = .03) and a lower incidence of catheter-related infections (Gr 1: A, 0.10 +/- 0.3 versus NA, 0.60 +/- 0.55, p = .01; Gr 2: A, 0.27 +/- 0.55 versus NA, 0.71 +/- 0.64, p = .02) than nonaffiliated patients.


CONCLUSIONS
Affiliation with an organization that provides ongoing HPN education and peer support was associated with significantly better HPN outcomes. Alternative explanations are discussed in relation to limitations of the case-control design.
Smith
Carol E
CE
School of Nursing, University of Kansas Medical Center, Kansas City 66160, USA.
Curtas
Susan
S
Werkowitch
Marilyn
M
Kleinbeck
Susan V M
SV
Howard
Lyn
L
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology / Q000592:standards; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000453:epidemiology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000523:psychology; D010353:Patient Education as Topic; D011788:Quality of Life; D012657:Self-Help Groups; D016896:Treatment Outcome