Funk Luke M, Jolles Sally A, Greenberg Caprice C, Schwarze Margaret L, Safdar Nasia, McVay Megan A, Whittle Jeffrey C, Maciejewski Matthew L, Voils Corrine I
Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin.
Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin.
Surg Obes Relat Dis. 2016 May;12(4):893-901. doi: 10.1016/j.soard.2015.11.028. Epub 2015 Dec 2.
Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization.
To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral.
Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin.
PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified.
Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery.
Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
美国每年接受减肥手术的重度肥胖成年人不到1%。了解影响其应用的因素至关重要。
了解初级保健医生（PCP）如何做出关于重度肥胖治疗和减肥手术转诊的决策。
在威斯康星州的小、中、大城市执业的PCP焦点小组。
要求PCP讨论对患有多种合并症的重度肥胖患者的治疗优先级以及关于减肥手术转诊的考虑因素。通过采用定向内容分析法对焦点小组会议进行分析。制定了共识代码分类法。创建了代码摘要并确定了代表性引述。
16名PCP参加了3个焦点小组。确定了四种治疗优先级方法：（1）治疗最容易解决的疾病；（2）治疗被认为最危险的疾病；（3）让患者设定议程；（4）首先解决肥胖问题，因为它是其他合并症的共同根源。只有后一种方法强调肥胖治疗。五个因素使PCP在转诊患者进行减肥手术时犹豫不决：（1）想“不造成伤害”；（2）质疑减肥手术的长期有效性；（3）对减肥手术的了解有限；（4）不想过早推荐减肥手术；（5）不知道保险是否涵盖减肥手术。
PCP对重度肥胖患者的决策似乎未将肥胖治疗置于优先地位，且高估了减肥手术的风险。这可以通过PCP教育以及改善PCP与减肥外科医生之间的沟通来解决。
