4732 Attitudes of family practitioners to percutaneous endoscopic gastrostomies in the community.

Abstract

The number of percutaneous endoscopic gastrostomies (PEGs) performed is increasing. Most of these patients end up in the community and are managed primarily by family practitioners. Despite this, there are no studies assessing the attitudes of family practitioners to PEG tubes. AIM: To assess family practitioners' attitudes to the PEG tubes and how management in the community may be improved. METHODS: A postal questionnaire was sent to a randomly selected family practitioner from each practice within N.Ireland (population 1.5 million). RESULTS: 275 responses from 365 family practitioners (75%). 91% of family practitioners had received no education regarding PEGs, 54% perceived their knowledge as poor, 38% as fair, 7% as good and 1% as very good. 79% would like to receive further education. 53% of family practitioners had patients with PEGs and 25% had referred patients for PEG insertion. Indications for insertion were stroke (48%); motor neurone disease (13%); multiple sclerosis(8%); dementia and anorexia (8%); cerebral palsy (6%); Parkinson's disease (3%) and other (14%). 53% had encountered problems with PEGs; tube blocked (30%); tube dislodged (25%); tube leakage (18%); local sepsis (16%); pain (8%) and other (3%). 40% of problems were managed in the community, 33% required emergency room attendance and 27% hospital admission. 78% thought a telephone advice line would be helpful. 80% saw a role for a nurse specialist. When asked who should perform PEG replacement in the community, 37% felt this required an outpatient procedure in hospital; 25% domicilary visit by a gastroenterologist; 10% nurse specialist; 10% emergency room attendance; 6% family practitioner and 12% did not know. 19% of family practitioners felt there were too many PEGs performed, 50% did not and 31% did not know. Family practitioners would like more education, review of guidelines re indications and ethics of PEG insertion, easier access to problem solving in the community and formatted follow-up. CONCLUSION: Management of patients with PEG tubes in the community could be improved by setting up a specialist service in the community involving gastroenterologists, family practitioners and nurse specialists.