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

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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.

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