Survey on legislation and funding of Home Artificial Nutrition in different European countries

Rationale: Home Artificial Nutrition (HAN) has been an expanding area over the last 30 years. HAN programs have been often developed prior to the regu lation by the National Health Systems (NHS) leading to different policies w ithin European countries. The aim of this study was to compare legislation regarding HAN in Europe. Method:The Group elaborated two structured questionnaires tone for Home Ent eral Nutrition - HEN - and one for Home Parenteral Nutrition - HPN) which w ere presented to all the members of the MAN-Working group and to the 21 ESP EN Council members. Results:Twelve questionnaires were returned, covering for more than 375 mil lion inhabitants. HEN: regulated in seven countries, Italy and France being the first to implement reimbursement policy in 1988. Except in France, Cro atia 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 withi n countries. As in HPN, most of the countries have written guidelines for h ealth care workers and for patients. HPN: legislated in six countries, Denm ark 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 H ome Care companies are involved in a different degree in providing and dist ributing 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 fol lowed by NST Despite different policies, funding is relatively uniform, NHS supporting most of the expenses for HAN. ESPEN could play a key role devel oping common standards for HAN all over Europe. (C) 2001 Harcourt Publisher s Ltd.