This document discusses intestinal failure services in Australia. It notes there is variability in care across jurisdictions and no national policy. It discusses the role of specialized centers, multidisciplinary teams, and intestinal rehabilitation. It also addresses issues like HPN funding models and variability. The document advocates for AuSPEN to help establish standards for an intestinal failure registry, model of care, and advocacy to improve access to specialized care nationwide.

1. Home PN in
Australia
Ibolya Nyulasi

2. Intestinal Failure
Services In Australia
Do we have any?
Dedicated health professionals doing their best….

3. Health Policy Advisory Committee
on Technology (HealthPACT)
• The Nationally Funded Centres (NFC) program
was established in 1990 by the Australian Health
• Ministers Conference (AHMC) to implement a
national policy for public sector provision of high
cost and highly specialised clinical practices and
technologies with limited demand, to ensure
equitable access to these practices and
technologies for all Australians

4. Health PACT
• Developing Australia’s capability to
perform intestinal transplantation may
provide Australians with better access to
this service. However, development of a
national intestinal transplantation service
capability should occur in the context of
an integrated, best practice service model
for management of intestinal failure

5. Health PACT
• Management of intestinal failure requires a multidisciplinary team
experienced in the assessment and treatment of this group of
patients. What are the current service arrangements for
management of patients with intestinal failure across
jurisdictions?
• Intestinal rehabilitation should be achieved wherever possible as
this option presents the best long-term outcome for patients and
avoidance of transplantation or PN. Successful intestinal
rehabilitation requires coordinated care to be delivered by a
multidisciplinary team experienced in the assessment and
management of intestinal failure. How is intestinal rehabilitation
being delivered across jurisdictions for patients in whom
rehabilitation indicated?

6. HPN Funding
• In Victoria
• 1.8.7 Total parenteral nutrition
• Additional funding will be provided to support total parenteral
nutrition (TPN) services provided to non-admitted patients who
self-administer TPN at home. The additional funding will assist
Victoria’s five health services that are funded to provide TPN to
transition to a model that better aligns funding with activity.
• Under the funding model for 2015–16 health services will continue
to be funded via a specified grant for TPN services and service
event targets will be introduced, based on an indicative price per
patient per month. Recall will be applied at the end of 2015–16 for
health services whose activity is below target. Ad hoc data and cost
reporting may be requested by the department throughout 2015–
16 to enable further analysis of activity and costs in order to inform
future funding approaches.

7. IndependentHospitalPricingAuthorityHomeEnteral
Nutrition,HomeParenteralNutritionand
HomeVentilationServicesCostingReport
January2015
• The Costing study on Home Enteral Nutrition, Home Total
Parenteral Nutrition and Home Ventilation Services
• The Costing study on Home Enteral Nutrition, Home Total
Parenteral Nutrition and Home Ventilation Services was
undertaken in 2014. The purpose of the study was to review
the costs associated with the delivery of public hospital
services to patients receiving home enteral nutrition, home
total parenteral nutrition and home ventilation services. The
study include a literature review, stakeholder consultation and
costing the respective services based on data collected from
the jurisdictions
• Identify the service model employed by the respective
hospitals in the delivery of the home based services, thereby
testing the similarities with some of the service models
identified in the literature;

8. Proportion of HTPN costs by
cost bucket
17.96%
14.38%
0.08%
66.56%
0.21%
0.48%
0.34%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%
Corporate Overheads
Medical Surgical Supplies
OnCosts (Labour)
Pharmacy Non PBS
Salaries Wages - Allied Health
Salaries Wages - Medical
Salaries Wages - Nurses
Percentage of Total Costs
CostBucket

9. Independent Hospital Pricing
Authority
• Few of the hospitals participating in the study
have dedicated teams that manage patients on
home based enteral or total parenteral nutrition
services. Management occurs via multi-
disciplinary teams
• Discussions with Australian clinicians involved
in the provision of HEN and HTPN services
suggest that the UK service delivery model may
represent an ideal service delivery model,
however it is not tenable in Australia.

10. Independent Hospital Pricing
Authority
• In the majority of instances, the dietetics
departments of the participating hospitals drove the
data collection for home enteral and home total
parenteral nutrition services.
• The involvement of pharmacy department staff in
the completion of time spent filling scripts was
variable, and may be understated, although it should
be noted that an overhead cost was allocated to the
Pharmacy cost bucket which would cover the costs
associated with administrative staff filling monthly
orders.

11. State Policy Funding Implications Service
Conducted By
WA No statewide
policy
Area Health
Services (AHS)
have own policies
Total monthly expenditure
captured in HEN cost centre.
Patient contributes the
service,
Dietetic/
Nutrition Services
ACT No formal policy Hospital Funded
ACT No formal policy Hospital Funded
NSW
Formal policy
PD2005_395:
Drugs – Funding
Arrangements for
Outpatient Use of
High Cost Drugs
Not Funded by the
Commonwealth.
This does not
specifically
mention TPN, but
TPN solutions are
covered by this
policy.
Products are funded by
hospitals. HTPN must be
commenced in a tertiary
centre. If the patient lives
in a different LHD, the
initiating LHD covers the
cost for the first 12
months then the cost is
transferred to the LHD
where the patient lives.
Nutrition and
Dietetics Services,
with clinical nurse
consultant (CNC)
consultation

12. AuSPEN
• Its Purpose
• Encourage knowledge enhancement and professional competence
in the field of nutrition therapy to improve patient nutritional care
and patient outcomes.
• Promote an evidence-based approach to nutrition in clinical
practice.
• Encourage membership involvement in research and its
dissemination.
• Provide clinical nutrition expertise in an advisory capacity to other
nutrition organisations, health professionals and government
bodies.
Its Role in IF

13. AuSPEN role in IF
• In the past
• Guidelines for HPN
• Registry
• Actively participating with ESPEN IF committee

14. AuSPEN Proposal
• Establish a new committee  Intestinal Failure
• Establish 3 working groups as part of this
committee
• Develop HPN registry
• Model of care and Quality
• Funding /advocacy

15. Future Plans for Registry
• Minimum data set
• Real time data
• Web based
• Ability to benchmark

17. NHS development 2013/14 Standard
contract for intestinal failure
• Population Needs
• Scope of service
• Aims and objectives of service
• Care pathway
• Referral processes
• Applicable Service Standards
• Key Service outcomes
• Type II IF
• IP line sepsis
• Post surgical survival
• Type III IF
• HPN patient central line sepsis
• Annual review of continued need for HPN and number of days of
feed required

18. Conclusion
• Intestinal Failure is a rare disorder with major impact on
patients, families and the health service
• Australia is lagging behind in recognising the need to
provide a comprehensive service and has no national
framework to address the complex issues that such
disorder. There is great variability in care and access to
care is not universal.
• AuSPEN has a major role to play in advocating for a
model of care that is cost effective, accessible and
delivers a quality care for patients along their IF jouney.