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Scand J Gastroenterol. 2019 Mar 27:1-5. doi: 10.1080/00365521.2019.1588370. [Epub ahead of print]

Fragmented management of long-term parenteral support for adult intestinal failure in Finland.

Author information

1
a Clinical Nutrition Unit, Internal Medicine and Rehabilitation , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
2
b Section of Pediatric Surgery, Pediatric Liver and Gut Research Group , Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
3
c Department of Gastroenterology , Abdominal Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.

Abstract

OBJECTIVES:

Parenteral support (PS) is the first-line therapy for intestinal failure (IF). Optimal patient outcomes require experienced multidisciplinary teams adhering to structured protocols. As practices to provide long-term PS for adult IF patients in Finland are unknown, this cross-sectional nationwide study aimed to evaluate current management of PS for adult IF across the country.

MATERIALS AND METHODS:

An internet-based survey was emailed to all Finnish hospitals and hospital-at-home services with the potential to provide PS for adult IF. The survey included 20 items addressing the provision of long-term PS for adult IF patients (aged ≥18 years). Data were analysed using descriptive statistics.

RESULTS:

Overall, 52 (47%) of the 111 identified units responded. Of responding units, 38 (73%) had at some point provided long-term (≥120 days) PS for adult IF, and 23 (44%) had done so during the preceding year. Only three units currently managed ≥3 adult patients. Most (65%) of the respondents worked in a hospital and were either physicians (38%) or dietitians (39%). Only 65% of respondents reported that their unit had an assigned physician responsible for PS provision, and 28% reported that a team was responsible for long-term PS. Only 26% of respondents reported having a written protocol to guide PS management.

CONCLUSIONS:

Health care providers with very limited experience and a fragmented approach manage most Finnish adult IF patients. Evidence-based protocols and multidisciplinary teams are scarce. The care for adult IF patients on long-term PS needs to be improved in Finland.

KEYWORDS:

Parenteral support; home parenteral nutrition; intestinal failure; intravenous supplementation; short bowel syndrome

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