A review of the current national status of home parenteral and enteral nutrition from the provider and consumer perspective.

Home parenteral and enteral nutrition (HPEN) has grown rapidly in the past decade. By examining data from physician reports, patient surveys, and the infusion industry, this review attempts to delineate the diagnostic indications, age range, mortality, medical complications and rehabilitation potential of HPEN patients. A clear trend exists towards greater use of this expensive therapy in bowel obstructed cancer patients and in pediatric and geriatric age groups. Complications in parenterally fed patients appear to result in a readmission to the hospital, on average, once every 2 yr. Life expectancy depends heavily on the underlying diagnosis: whereas 50% of the patients with a malignancy survive only 6 months, 50% without a malignancy survive beyond 3 yr. Fifty to 60% of HPEN patients are able to work full time or part time, 15 to 20% are retired or of preschool age, and 20 to 30% are unable to work. The home care service options considered most important by patients are the pharmacy premixing of intravenous solutions, home delivery of supplies by the home service carrier, reimbursement management by the home care service and the availability of a nurse for an initial home visit and 24-hr emergency backup. In regard to fiscal concerns one of the difficult issues that should be addressed is the separation of medical coverage from disability status; another is that enteral feedings can sometimes be a less expensive alternative to parenteral feedings but little information exists about the complications and outcome with this modality and its fiscal reimbursement is much less assured.