A survey on percutaneous endoscopically placed gastrostomy in the northwest: influence of work setting

Abstract

A survey was undertaken to determine the influence of practice setting on the way Pacific Northwest gastroenterologists perform and manage percutaneous endoscopically placed gastrostomy (PEG). A 12-question survey was distributed to 196 members of the Pacific Northwest Gastroenterology Society (PNWGS) regarding their specifics of placing and managing PEG. The responses were compared according to work setting, i.e., private practice, armed services, staff model HMO's, and university affiliated hospitals. The data were analyzed using the chi2 test. Sixty-nine of 126 practicing gastroenterologists responded; 75% were in private practice (PP) and 25% in the combined other work settings (non-PP). The mean number of PEG placed by all groups was 23. Seventy-three percent of PP performed PEG without a second physician. Antibiotics were used prophylactically in both PP and non-PP by 96%. There was no difference between groups in use of standardized forms or in time before instituting feedings. The non-PP groups used preprocedure labs (p = 0.037) and loosening skin surface bumpers (p = 0.035) more frequently. The uniform impression was that PEG was associated with the same or fewer complications currently than in the past. In the PP setting, gastroenterologists tend to place PEGs without a second physician and use standardized forms and bumper loosening less frequently than non-PP gastroenterologists. These variations reflect that teaching institutions as well as staff model HMOs make access to an assistant easier. Respondents expressed confusions on billing for PEG. They perceived the procedure to be as safe or safer than in the past. The PEG has evolved into a frequently performed procedure whose practice variations are outgrowths of one's work environment as well as one's training.