Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

Abstract

Background Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. Methods A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman’s correlations and regression analyses. Results Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = − 0.355, p < 0.001) and between positive attitudes and concerns (r = − 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1–0.7). Conclusion According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.

Knowledge, attitude and practice of bariatric surgery among primary care physicians in Riyadh, 2020

“…Sufficient knowledge about obesity and bariatric surgery in primary health care is an important element that might positively affect referral patterns and physicians practice. In a previous study, high knowledge was significantly correlated with better referral and positive attitude (Memarian et al, 2021). The finding of this study showed that patients who were older than 30 years and who had more than 5 years in practice demonstrated significantly better knowledge about bariatric procedures.…”

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“…Currently, studies from European countries and the USA have reported that primary care physicians remain reluctant to refer their patients for bariatric/ metabolic surgery. This may be associated with a lack of knowledge [34][35][36][37]. In the results of an interview with the general public in Saudi Arabia, most participants recognized the association between obesity and its comorbidities.…”

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“…Despite numerous publications on the safety and effectiveness of bariatric surgery in producing durable weight loss and resolving obesity-related comorbidities, its penetration in the medical community remains limited. A recent survey among Swedish PCPs has shown that half of the respondents had high concerns about postoperative complications relating to bariatric surgery and this may lead to non-referral [ 29 ]. An individual’s choice to pursue bariatric surgery may also be influenced by familial involvement and support, and cultural and/or religious beliefs [ 30 ].…”