General Practitioners involvement in enteral tube feeding at home: a qualitative study.
BACKGROUND
Complex medical treatment is moving from hospital to primary care and General Practitioners (GPs) are increasingly asked to undertake new roles. There are now an estimated 19,500 patients being fed in the UK in the community on enteral tube feeding using a variety of different feeding tubes (Percutaneous endoscopic gastrostomy (PEG), Jejunostomy, or nasogastric (NG). The majority of patients are over the age of 65 years when they had artificial feeding initiated and mainly because of dysphagia. The aim of this study was to explore GPs knowledge, attitudes and skills relating to enteral feeding in the community.


METHODS
Semi-structured one-to-one interviews with a convenience sample of GPs in Northern Ireland.


RESULTS
Twenty-three GPs in three health boards in Northern Ireland participated in the study. Most found dealing with enteral feeding to be a predominantly negative experience. They had little involvement in patient selection for the procedure and poor or no discharge information. GPs felt inadequately trained, there was poor communication between primary and secondary care and little support. There was anger and frustration among GPs about lack of resources (funding and training), and the perception that primary care was used as a dumping ground.


CONCLUSIONS
Moving complex medical treatment from secondary to primary care has major implications for GPs who should be included in the patient selection process, have adequate discharge information about their patients, be adequately resourced and have appropriate support and training.
Madigan
Sharon M
SM
Community Nutrition and Dietetics Service, Belfast Health and Social Care Trust, Belfast, Co. Antrim, UK. sharon.madigan@ntlworld.com
Fleming
Paul
P
McCann
Siobhan
S
Wright
Marion E
ME
MacAuley
Domhnall
D
D000328:Adult; D000359:Aftercare / Q000592:standards*; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D004750:Enteral Nutrition / Q000379:methods; D005194:Family Practice / Q000193:education*; D005260:Female; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D016134:Organizational Policy; D018579:Patient Selection; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D040841:Resource Allocation