Essential paths to guarantee adequate care and assistance to all patients in need of Artificial Nutrition.
Florence, 20 May 2024 – Presented in Tuscany today, ‘THE CHARTER OF RIGHTS OF PATIENTS ON ARTIFICIAL NUTRITION‘, during the event promoted by Healthcare Engine and from ANNA
. – National Association of Artificially Fed, with the patronage of ASAND (Scientific Association of Food, Nutrition and Dietetics) e SINPE (Italian Society of Artificial Nutrition and Metabolism) and the unconditional contribution of SAPIO life, TAKEDA And VIVISOL Home Care Services. This is an essential therapeutic procedure for those who cannot eat naturally, fundamental in cases of malnutrition, hypercatabolism, cachexia and the need for intestinal rest.
In Italy only 94 centers for 625,000 inhabitants
Malnutrition, often underestimated, aggravates pathologies, prolonging hospitalizations and increasing healthcare costs. Patients with chronic gastrointestinal, neurological and oncological diseases, as well as malnourished children and elderly people, may require artificial nutrition. This can be administered via nasogastric tube or stoma (enteral nutrition), or intravenously (parenteral nutrition). Management requires the use of electronic pumps and nursing materials to avoid complications. In Italy, there are only 94 artificial nutrition centers, on average one for every 625,000 inhabitants, with an inadequate territorial distribution. Tuscany, despite a good regulatory framework, must improve access to care and the transition from pediatric to adult care and the presentation of the Bill of Rights – previously presented in Piedmont – is an important step towards fair and adequate treatment for all patients who depend on artificial nutrition.
THE POINTS THAT EMERGED
Optimization of the home service for the patient’s quality of life
Alessandra Rivella, President of the ANNA Association, highlights the importance of the home service, which must combine adequate therapy with safeguarding the patient’s quality of life. This is achieved through targeted assistance and the use of technologies and devices that increase safety in administration and improve quality of life. “It is fundamental, both for the well-being of the patient and for the savings of the health system, train care staff to prevent complications and reduce hospital admissions“, underlines Rivella.
Which also means “enabling patients and caregivers to face the challenges of home artificial nutrition with confidence and resilience, improving their quality of life,” he adds. Serena TorsoliASAND Tuscany Region Representative.
The importance of the Diagnostic Therapeutic Care Path and its complexity in regional management
Barbara Paolini, President of ADI, highlights the lack of homogeneity in the management of home artificial nutrition and underlines the importance of a shared Diagnostic Therapeutic Care Path to guarantee continuous and appropriate nutritional paths for patients. “The lack of homogeneity that characterizes the management of Home Artificial Nutrition on the national territory is now well known – he reiterates -, with organizational variations between regions and gaps in the achievement of fundamental objectives. Guaranteeing the patient a continuous, appropriate and easy nutritional path represents an essential aspect, especially in light of the increase in conditions that require the use of Home Artificial Nutrition”.
On how to govern the complexity of managing a Diagnostic-Therapeutic-Assistive Path shared at a regional level, involving various actors and processes, Maria Luisa Eliana Luisi, President of ADI Toscana: “We need simple rules that can be adapted to situations. The methodology proposed by Mary Lippitt requires vision, skills, incentives and an action plan to produce the desired change.”
Need for a multidisciplinary team for children with special nutritional needs and guarantee of adequate and timely assistance
Laura Chiesi And Laura LacitignolaHeads of UP Dietetics AOU Meyer IRCCS and SOC of Gastroenterology and Nutrition Meyer IRCCS University Hospital, Florence, underline the importance of pediatric artificial nutrition in improving the prognosis in some pathologies and the essentiality of a multidisciplinary team to ensure the best support for children with special nutritional needs. “The evaluation of the nutritional status is crucial in the approach to the child, considering the dynamic needs for growth and anabolism influenced by pathologies. The multidisciplinary team in pediatrics is essential to guarantee the best choices and the necessary support for children, as indicated by resolution 618 of 2001 which established the Meyer multidisciplinary team as a regional reference center”.
Also Rita Barbara Marianelli, Vice President of the National Register of Dietitians, reiterates the need to guarantee adequate and timely assistance to all patients. “The nutrition care path must be humanised, recognizing the centrality of the patient and caregivers, guaranteeing continuity in assistance to respond in an innovative way to the social and epidemiological context”.
“Our regional organization guarantees optimal care through a synergistic network of professionals who work in the hospital and in the area”, he insists Valentina Culicchi, Acting Director UOSD Clinical Nutrition Southeast. “The organization provides for a constant exchange with general practitioners and the District Areas, ensuring continuity in home and community care for patients requiring complex artificial nutrition, with the collaboration of external providers for uniformity and quality of treatment” .
Promotion of the regional Diagnostic Therapeutic Assistance Path for oncology nutritional support
Gianni AmunniIspro Scientific Coordinator and Director of the Careggi Oncology Department, Florence, promotes a Regional Diagnostic Therapeutic Assistance path for the nutritional support of cancer patients, involving numerous professionals in the process. “The Tuscan oncology network has developed a regional PDTA for the nutritional support of cancer patients, involving over 40 representative professionals. These recommendations will be formalized by the region, with the aim of ensuring early nutritional assessment and personalized care for all cancer patients. A comprehensive approach is envisaged which includes nutritional assessment to identify the need early, followed by targeted support through dietary counseling and the use of nutritional supports, including enteral or parenteral nutrition according to the needs of the individual patient”.
Irreplaceable role of artificial nutrition in the treatment of eating disorders for patients with complex needs
Stefano LucarelliActing Director UFC Eating Disorders AUSL Toscana Centro, reiterates the irreplaceable role of artificial nutrition in the treatment of nutrition and eating disorders, with a multi-professional assessment of the patient to ensure appropriate interventions. “Enteral nutrition – he adds – represents the first choice and is activated only after receiving the patient’s informed consent according to the rules of the current code of ethics”.
“We must all make an effort, with transversal skills, to ensure that the system that takes care of these patients works as best as possible”, he urges Francesco Sofi, Director of SOD Clinical Nutrition, Careggi University Hospital, Florence. “With the aim of improving the quality of life of patients, as well as giving them years of life”.
“Nutrition is one of the most important determinants of health, together with education and movement, and guaranteeing it even when physiological obstacles exist is fundamental for patients in different stages of life and health,” he continues Simona Dei, Health Director of the Local Health Authority of Central Tuscany. “There are many possibilities, different professional roles involved, it is important to address the issue as a team, building a protective network – a concept also shared by Silvia PulitiHead of Clinical Nutrition Network, Local Health Authority of Tuscany Center – which in the various phases alternates the professionals involved on the front line, gradually and respecting the complexity of the framework”.
Tuscany virtuous example
Filippo Lintas, President Home & Digital Care Confindustria Dispositivi Medici, finally highlights the importance of strengthening home care services in the field of artificial nutrition. “To improve home care services in the field of artificial nutrition, a great commitment is necessary to guarantee care through integrated, but above all homogeneous services and therapies throughout the territory. Tuscany has made great progress in recent years, providing home nutritional services for all patients in the region, also designing an integrated model which provides for the contextual provision of home therapies for chronic patients and those with comorbidities and which, in our opinion given the excellent results obtained, it should be taken as an example by other regions”.
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