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, a nd to consider the causes and implications of differences in the geogr aphic prevalence of HETF. Design: A 1-year prospective study. Setting: Eight independently funded districts within East Anglia. Subjects: Ba sic 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, complic ations 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 t he British Association of Parenteral and Enteral Nutrition. Results: T he 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 initia ted in hospital but in this survey we found inadequate training for ho me care in 23%, inadequate support and follow-up in 20%, inadequate eq uipment in 41%, uncertainties regarding organisation, and various clin ical 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 v aried fourfold between districts) and the number of NHS dieticians per head of population; and an inverse correlation with respect to reques ts by patients for more support (r = 0.97), complaints of blocked tube s (r = 0.82) and the need for hospital help. Conclusion: HETF provides an important form of support to a small group of severely disabled pa tients. There are important differences between districts in the preva lence 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 an d Parenteral Nutrition in the community.