It is a lifesaving therapy. For patients who need this type of diet, hospitalization is not essential
Those who are unable to feed themselves orally can also resort to artificial nutrition at home, free of charge, through the National Health Service. Home artificial nutrition is activated when essential for the person’s survival. a life-saving therapy that allows patients to be treated at home, avoiding long hospitalizations just to be fed with the tube. Region you go to, service you find. The models of taking charge and the quality of assistance vary not only from region to region, but also from ASL to ASL, even from district to district. There is no national law that defines the requirements and guarantees equal access to citizens, he says Maurizio Muscaritolidirector of the complex operational unit of Internal Medicine and Clinical Nutrition of the Umberto I Polyclinic in Rome and president of the Italian Society of Clinical Nutrition.
Malnutrition risk
About half of the elderly who enter the hospital are at risk of malnutrition. The loss of weight and muscle mass worsen the prognosis and the effectiveness of the treatmentsthe. And in two out of ten cancer patients malnutrition causes death as it reduces the tolerability of treatment. it is important to intercept nutritional needs in the area early on underlines Riccardo Caccialanzahead of the complex operational unit of dietetics and clinical nutrition of the San Matteo polyclinic in Pavia.
Who can get it
Artificial nutrition consists of the infusion of standard or customized nutritional blends. Can occur through the digestive (enteral) routevia a tube in the nose that reaches the stomach (for shorter treatments) or by inserting a tube into the stomach or intestine through a hole made in the abdomen. Or by vein (parenteral) using a catheter placed on the neck, chest or arm. The start-up procedures are performed in hospital. The indication for enteral nutrition concerns patients with dysphagia, i.e. difficulty in swallowing food and liquids, associated with tumors (of the head and neck area, esophagus, stomach, duodenum) and neurological pathologies (cerebral coma, outcomes of brain trauma or stroke, chronic degenerative diseases such as Parkinson’s, senile dementia, ALS). While parenteral it is carried out mainly in the presence of intestinal insufficiency, due to cancer, short bowel syndrome, severe malabsorption, chronic inflammatory bowel diseases, rare diseases.
No certificate of disability, nor do you pay the ticket
Artificial nutrition is prescribed even in severe cases of anorexia reminiscent of Muscaritoli. The certificate of invalidity is not required and the ticket is not paid. Patients must accept the treatment by signing a signed consent (in cases of disqualification the guardian is expressed). If they are unable to self-manage therapybecause they are enticed or frail,a caregiver is involved.
How does it work
A law was instituted only in Piedmont, Veneto and Molise which regulates a homogeneous assistance network. In the other regions, each health company organizes itself independently on the basis of regional resolutions. In November Lombardy approved a shared care pathway and a unique regional digital platform for prescribing and monitoring nutritional therapies. The implementing decrees are expected in the coming months. Despite the difference in the offer, the procedures for taking charge are almost the same from North to South. The discharge from the hospital of a patient who is a candidate for nutritional therapy is always a protected discharge, therefore before discharge, the ward requests nutritional advice and, if necessary, the activation of the integrated home assistance service (Adi) for training the caregiver in the use of the infusion pump (provided on loan for use), checks and management of any complications at home. The clinical nutrition team (doctor, nurse, dietician and pharmacist) belonging to the hospital, having verified the patient’s suitability (with examination and blood tests), establishes the dietary plan. If the person is not autonomous, the ASL multidimensional assessment group defines an individual assistance plan (Pai) based on the nutritional program. At this point the patient can benefit from Adi’s service.
Periodic evaluation
Periodic evaluation of the patient’s condition and changes in the diet plan are up to the physician of the nutritional structure. The home artificial nutrition service cannot be booked through Cup. Whether the patient at home will be the general practitioner (or pediatrician)by filling in a specific form, to report the case to the hospital clinical nutrition structure which sometimes also manages the territorial activity, making use of peripheral offices (in the smallest hospitals). A prescription from a nutritional specialist is always required (in ambulatory clinic) by your GP, who forwards it to the clinical nutrition facility directly or through the Adi service (if the patient has already been taken care of).
Nursing support
According to the needs of the family, the doctor will apply for nursing support in collaboration with the ADI or palliative care, and will prescribe the blood tests useful to establish the nutritional status of the patient. In Umbria the citizen books the service from the nutritionist of the local health center to whom he will deliver the recipe. In Calabria there is a home artificial nutrition service at the Reggio Calabria health company that follows both patients in protected discharge and cases sent by family doctors – explains Demetrio Quattrone, referent of the service -. In the rest of the region managed by a team or a doctor from the hospital with the support of ADI. The same in Sicily and Sardinia. The supply of bags and bottles with nutritional solutions is delivered to your home or collected at the district pharmacies.
March 10, 2022 (change March 10, 2022 | 20:08)
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