Abstract
Background
Despite the increasing obesity prevalence among American adults, relatively few qualified patients proceed to bariatric surgery. Suggested explanations include referral barriers for weight loss management at primary care provider (PCP) visits. This study aims to assess the referral and practice patterns of PCPs treating patients with obesity. Our goal is to understand treatment barriers in order to implement targeted interventions that enhance quality of care.
Methods
A 39-question electronic survey was emailed to PCPs at a single academic institution with community physicians. Questions explored providers’ demographics, referral patterns, and knowledge of pathophysiologic obesity mechanisms and bariatric surgery qualifications. Frequency and univariate analyses were performed and compared providers’ demographics, positions, and BMIs between referring providers and non-referring providers.
Results
Of 121 surveys distributed, we achieved a 33.9% response rate (n = 41). 78.0% stated that > 15% of their patients in the preceding year were classified as obese. PCPs indicated initiating weight loss management conversations < 50% of the time with 48.8% of patients. Provider-identified barriers to discussing weight loss surgery included being unsure if patient’s insurance would cover the procedure or if patients would qualify (24.4% vs. 19.5%). In addition, 43.9% of providers felt that the risks of bariatric surgery outweigh the benefits.
Conclusion
Despite a large percentage of patients cared for by PCPs being classified as obese, few providers initiate discussions on weight loss options with potentially eligible surgical candidates. The barriers identified indicate an opportunity for improved education on patient qualifications, strategies for streamlining conversations and referrals, and reinforcement of the safety of surgical weight loss. Providers’ desire for this education demonstrates an opportunity to work toward minimizing the referral gap by increasing patient conversations about these topics.
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Abbreviations
- PCP:
-
Primary care provider
- LSG:
-
Laparoscopic sleeve gastrectomy
- RYGB:
-
Roux-en-Y gastric bypass
- BMI:
-
Body mass index
- APP:
-
Advanced practice provider
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Dr. Jon Gould is a consultant for Ethicon/Torax Medical, Gore, and Stryker. Ms. Emily Horecki Lopez, Ms. Melissa Helm, Jon C. Gould, and Dr. Kathleen Lak have no conflicts of interest or financial ties to disclose.
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Accepted as a Podium Presentation at the SAGES 2019 Annual Meeting, Baltimore, Maryland.
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Lopez, E.K.H., Helm, M.C., Gould, J.C. et al. Primary care providers’ attitudes and knowledge of bariatric surgery. Surg Endosc 34, 2273–2278 (2020). https://doi.org/10.1007/s00464-019-07018-z
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DOI: https://doi.org/10.1007/s00464-019-07018-z