P268 - COMPARISON OF PARENTERAL NUTRITION PRACTICES IN THREE COUNTRIES

P268

COMPARISON OF PARENTERAL NUTRITION PRACTICES IN THREE COUNTRIES

T. Lac^1,*, Y. A. Xia², G. Hardy³

¹Medicine, Karolinska Institute, Stockholm, Sweden, ²Nutrition Services, Auckland City Hospital, ³R & D, Ipanema Trust, Auckland, New Zealand

Rationale: Parenteral nutrition (PN) is a therapeutic option for patients with intestinal failure that is available in all countries surveyed recently, but not necessarily at home (HPN). Product availability, reimbursement and local practices, but not national income, influence clinical nutrition services in different countries¹.

Methods: We have compared data on PN prescribing, supply and reimbursement for Vietnam (VI) with New Zealand (NZ) and Sweden (SW).

Results: Adult PN is primarily administered from 2- and 3-chamber bags (CB), occasionally as all-in-one admixtures in NZ and SW but rarely in VI where bottle systems are used for kidney or liver-sparing amino acids and in children's hospitals. Daily costs range widely: adults 55-155 €/d; neonatal/paediatric 28-150 €/d.

        - Preparation/Supply is via hospital pharmacies, mostly outsourced in NZ and SW, but in VI paediatric PN is often prepared by nurses depending on the hospital's available facilities.

        - Reimbursement is comprehensive in NZ and SW but in VI coverage varies by hospital classification. Health insurance covers 100% for bottles, 2-CB, micronutrients in rural, public hospitals and paediatrics <6 years old, whereas most adults and paediatrics >6 years receive only 80% coverage. Patients with insurance are reimbursed in private hospitals but only for 50% of 3-CB cost. Private insurance covers the hospital room, drugs and PN. HPN must be self-covered and purchased from an outside pharmacy.

        - Prescribing is primarily by physicians, or in NZ by a nutrition support team (NST) where established, but nutrition doctors in VI are consulted for recommendations. Intensivists often prescribe PN without consultation.

Conclusion: Ideally reimbursement should be comprehensive for life saving PN in hospital or at home. Ward preparation by nurses is concerning. A multidisciplinary NST is advantageous, but the concept of nutrition doctors merits further evaluation.

References: 1.Klek S et al Nutrition 2024;123:112396

Disclosure of Interest: None declared