Factors Influencing Primary Care Physicians' Referral for Bariatric Surgery

Abstract

Background and Objectives:Bariatric surgery has been shown to be an effective weight loss treatment for the morbidly obese, but some primary care physicians remain hesitant about postoperative treatment and management of patients who have undergone the surgery and recommend it to their obese patients infrequently. The purpose of this study was to evaluate perceptions of primary care physicians of the role of bariatric surgery in the management of obese patients and to identify possible barriers to treatment.Methods:A survey of PCPs within our institution was conducted to determine attitudes, knowledge, and practices regarding the treatment of morbidly obese patients, with a specific focus on identifying factors that influence referral patterns for bariatric surgery.Results:Among 161 eligible PCPs, 57 (35.4%) responded. Most respondents (59%) reported that at least 1 in 4 of their patients had a BMI ≥35 kg/m2. Although 39% thought that diet and exercise were an effective means of sustained weight loss, only 12% were satisfied with prescribing nonsurgical interventions. Sixty-three percent agreed that bariatric surgery is generally effective in the long term. All respondents were aware of the commonly established benefits, including improvement of diabetes, hypertension, and hyperlipidemia. In addition, 65% were familiar with the indications for bariatric surgery, and 70% felt comfortable discussing it with patients as a treatment option. Fewer than half of the respondents felt confident in providing postoperative management. Cost was a perceived limitation, with 53% reporting that most of their patients could not afford bariatric surgery.Conclusions:The general attitude of PCPs toward bariatric surgery is supportive. Physicians are largely aware of the indications and benefits; however, far fewer are comfortable in management of patients after surgery. A lack of supplemental information and concerns regarding the cost of surgery can impede treatment and referrals.

The knowledge of Polish primary care physicians about bariatric surgery.

“…In our study 75.5% of physicians were able to explain to their patients how the bariatric operations are performed, and 69.8% of respondents could name the most commonly performed bariatric procedures. Tork et al published in 2015 results of a survey presented to primary care physicians which indicated that all respondents were aware of the benefits of bariatric surgery, including diminishing diabetes, hypertension and hyperlipidemia [21]. A publication by Auspitz et al showed that 48.1% of physicians responding to the survey support metabolic surgery for patients with diabetes [24].…”

“…Also most of the physicians (93.6%) agree that metabolic surgery can help to reduce treatment costs for syndrome X. The survey by Tork et al showed that most respondents (59%) reported that at least 1 in 4 of their patients had a BMI ≥ 35 kg/m 2 , but only 9% indicated that they frequently or almost always refer their morbidly obese patients to bariatric surgeons [21]. In a study by Auspitz et al , 87% of physicians had referred patients for bariatric surgery, but most (70.2%) had referred no more than 5% of their morbidly obese patients within the previous 12 months [24].…”

“…Most of the participants (63.1%) stated that they send 1–4 patients a year to a bariatric surgeon, but also a large number of doctors (51%) declared they had 5–19 candidates for the surgical treatment of obesity. Results obtained by Tork et al showed that 63% of physicians who answered the survey believed that providing educational pamphlets and seminars to GPs on the topic of treatment and management of morbidly obese patients would increase referrals to bariatric surgery [21]. In the publication by Auspitz et al , 92.5% of respondents would like to receive more education about bariatric surgery [24].…”

“…According to a study conducted between 2010 and 2011 in Poland, GPs were not able to identify patients for bariatric procedures, although most of them were familiar with the term ‘bariatrics’ [20]. It would seem that a lot of physicians were not considering bariatric surgery as a therapeutic option for their patients [21]. Since 2011, an extensive education concerning surgical treatment of obesity has been introduced among students, surgeons and specialists in other medical disciplines.…”

Mindset and Communication Barriers in the Diffusion of Bariatric Surgery

“…However, to get listed for surgery, patients often need PCP referral. Tork et al evaluated potential barriers to BS referral among PCPs in Ohio [43].…”