Survey of Perceptions and Educational Needs of Primary Care Providers Regarding Management of Patients with Class II and III Obesity in Ontario, Canada

Abstract

Background: Primary care providers (PCPs) are typically the primary contact for patients with obesity seeking medical and surgical weight loss interventions; however, previous studies suggest that fewer than 7% of eligible adult patients are referred to publically funded medical and surgical weight loss interventions (MSWLI)Methods: We performed an anonymous survey study between October 2017 and June 2018 to explore the knowledge, experiences, perceptions, and educational needs of PCPs in Southeastern Ontario in managing patients with class II and III obesity. Results: Surveys were distributed to 591 PCPs (n=538 family physicians; n=53 nurse practitioners) identified as practicing in the Southeastern Ontario and 103 (15.6%) participated. PCPs serving a rural population estimated that 14.2±10.9% of patients would qualify for MSWLI compared to 9.9±8.5% of patients of PCPs serving an urban population (p=.049). Overall, 57.5% of respondents did not feel competent prescribing MSWLI to patients with class II/III obesity, while 69.8% stated they had ‘good’ knowledge of the referral criteria for MSWLI. 22.2% of respondents were hesitant to refer patients for bariatric surgery (BS) due to concerns about postoperative surgical complications and risks associated with surgery. Only 25% of respondents were comfortable providing long-term follow up after BS, and only 39.1% had participated in continuing education on management of patients with class II/III obesity in the past five years. Conclusion: The majority of PCPs believe there is a need for additional education about MSWLI for patients with class II/III obesity. Future studies are needed to develop and compare the effectiveness of additional education and professional development around risks of contemporary BS, indications to consider referral for MSWLI, management and long-term follow-up of patients after BS.

Undergraduate medical education interventions aimed at managing patients with obesity: A systematic review of educational effectiveness

“…Despite an increasing number of studies in the last decade describing educational interventions aimed at management of patients with obesity at the UGME level, the ongoing lack of preparedness of graduating medical students and primary care providers to manage patients with obesity suggests that the interventions discussed herein have either had insufficient time to take effect, or have been too sparsely implemented, or both. 8,9 Although we find increasing awareness of this issue encouraging, we note that addressing the obesity epidemic by prioritizing the teaching of primary prevention and management of patients with obesity has been a matter of concern in medical schools in the United States for over 30 years. 59 As such, our finding of only 17 relevant studies in this review likely reflects an ongoing lack of engagement with these concerns and suggests that the necessary changes to medical school curric-…”

“…With obesity being a worldwide epidemic with profound implications on our society's health and wellness, physicians have a professional and social responsibility to assess, manage, and counsel patients with obesity. Despite the requirement to manage patients with obesity in their clinical practice, primary care providers report feeling poorly prepared for this management 8 . Moreover, this lack of preparedness appears to span the entire continuum of medical education with a survey of 40 medical schools in the United States in 2018 demonstrating that U.S. medical schools are not adequately preparing their students to manage patients with obesity 9 …”

“…Despite the requirement to manage patients with obesity in their clinical practice, primary care providers report feeling poorly prepared for this management. 8 Moreover, this lack of preparedness appears to span the entire continuum of medical education with a survey of 40 medical schools in the United States in 2018 demonstrating that U.S. medical schools are not adequately preparing their students to manage patients with obesity. 9 A systematic review in Undergraduate Medical Education (UGME) conducted by Vitolins et al in 2012 identified a scarcity of literature surrounding effective educational interventions aimed at teaching management of patients with obesity to medical students.…”

Evaluation of a Bariatric Monitoring Pass for Primary Care Physicians

“…Additionally, recent studies have shown improvements in BS safety, largely due to the advancements in laparoscopic surgical techniques [37], which also makes this kind of obesity therapy more popular. In contrast as mentioned above, GPs are concerned over providing long-term care [36] due to a lack of knowledge [38, 39] and missing education programs [31, 40]. Educational strategies to address these barriers should target continuous knowledge transfer regarding topics in the long-term treatment after BS.…”

Overlooked and under‐evidenced: Community health and long‐term care service needs, utilization, and costs incurred by people with severe obesity

“…47 Importantly for this population, shifting away from a weight-centric approach to one focused on wider person-centred outcomes, 48 including maintaining or achieving functional independence, potentially holds benefit for both individuals and service providers. Training for community staff, who often have sustained input with individuals, but feel ill-equipped to discuss weight, 49 could lead to health gains.…”