The Challenges of Home Enteral Tube Feeding: A Global Perspective

Abstract

The aim of this review is to provide a global perspective of Home Enteral Tube Feeding (HETF) and to outline some of the challenges of home enteral nutrition (HEN) provisions. It is well established that the number of patients on HETF is on the increase worldwide due to advances in technology, development of percutaneous endoscopic gastrostomy techniques, and the shift in care provisions from acute to community settings. While the significance of home enteral nutrition in meeting the nutritional requirements of patients with poor swallowing reflexes and those with poor nutritional status is not in doubt, differences exist in terms of funding, standards, management approaches and the level of infrastructural development across the world. Strategies for alleviating some of the challenges militating against the effective delivery of HETF including the development of national and international standards, guidelines and policies for HETF, increased awareness and funding by government at all levels were discussed. Others, including development of HEN services, which should create the enabling environment for multidisciplinary team work, clinical audit and research, recruitment and retention of specialist staff, and improvement in patient outcomes have been outlined. However, more research is required to fully establish the cost effectiveness of the HEN service especially in developing countries and to compare the organization of HEN service between developing and developed countries.

Home enteral nutrition recipients: patient perspectives on training, complications and satisfaction

“…However, it may be associated with psychological distress, and sometimes reluctance among HEN patients to leave their homes 2. Globally, HEN can attenuate cumulative projected patient care costs through a reduction in hospital admission and complications including hospital acquired infections 3. In an era where the cost of disease related malnutrition and associated prolonged hospital stay is being tackled in our healthcare systems, the role of HEN is set to expand.…”

Recent Advances in Enteral Nutrition

“…These include problems of funding, inadequate or lack of standards, policies, management approaches, guidelines and infrastructure for the delivery of enteral nutrition [23]. Therefore, strategies for ameliorating these challenges should include the development of the Home Enteral Nutrition (HEN) service which should promote multi-disciplinary team working and the development of national and international standards and guidelines [23].…”

“…These include problems of funding, inadequate or lack of standards, policies, management approaches, guidelines and infrastructure for the delivery of enteral nutrition [23]. Therefore, strategies for ameliorating these challenges should include the development of the Home Enteral Nutrition (HEN) service which should promote multi-disciplinary team working and the development of national and international standards and guidelines [23]. The National Institute for Health and Care Excellence (NICE) guidance on nutrition support [24] emphasizes the quality standard for nutrition support in adults and stresses the need for all care services to be responsible in identifying those who are at risk of malnutrition and providing nutrition support for the people who need it.…”

People with enteral tubes and their carers' views of living with a tube and managing associated problems: A qualitative interview study

“…The provision of nutrition and fluid via enteral tube (ET) is an essential therapy for people unable to meet their nutritional or hydration needs by oral intake alone. Whilst this has long been a common therapy in hospitals, an increasing number of people receive nutrition and fluid via ET in the home setting (Ojo, ). The number of people receiving this therapy is difficult to estimate (Ojo, ).…”