Home parenteral nutrition: does affiliation with a national support and educational organization improve patient outcomes?

Abstract

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.

• Authors: Carol E Smith, Susan Curtas, Marilyn Werkowitch, Susan V M Kleinbeck, Lyn Howard
• Journal: JPEN. Journal of parenteral and enteral nutrition (JPEN J Parenter Enteral Nutr) 2002 May-Jun Vol. 26 Issue 3 Pg. 159-63 ISSN: 0148-6071 [Print] United States
• PMID: 12005455 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adult
• Aged
• Case-Control Studies
• Catheters, Indwelling (adverse effects, microbiology, standards)
• Depression (etiology, prevention & control)
• Equipment Contamination (prevention & control)
• Female
• Humans
• Infection Control (methods)
• Infections (epidemiology)
• Interviews as Topic
• Male
• Middle Aged
• Parenteral Nutrition, Home (adverse effects, psychology)
• Patient Education as Topic
• Quality of Life
• Self-Help Groups
• Treatment Outcome