Department of Surgery, Medical College of Wisconsin, 8900 W. Doyne Avenue, Milwaukee, WI, 53226, USA.
Department of Surgery, Medical College of Wisconsin, 8700 W. Watertown Plank Road, Milwaukee, WI, 53226, USA.
Surg Endosc. 2020 May;34(5):2273-2278. doi: 10.1007/s00464-019-07018-z. Epub 2019 Jul 31.
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.
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.
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.
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.
尽管美国成年人的肥胖患病率不断上升，但只有相对较少的符合条件的患者接受减重手术。有研究建议，这可能与初级保健提供者（PCP）在就诊时对减重管理的转诊障碍有关。本研究旨在评估治疗肥胖患者的 PCP 的转诊和实践模式。我们的目标是了解治疗障碍，以便实施有针对性的干预措施，提高医疗质量。
对一家学术机构的社区医生进行了一项 39 个问题的电子调查。问题探讨了提供者的人口统计学、转诊模式以及对肥胖病理生理机制和减重手术资格的了解。进行了频率和单变量分析，并比较了转诊提供者和非转诊提供者的提供者人口统计学、职位和 BMI。
在分发的 121 份调查中，我们获得了 33.9%的回复率（n=41）。78.0%的人表示，在前一年中，他们的患者中有>15%被归类为肥胖。PCP 表示与 48.8%的患者进行减重管理对话的时间<50%。提供者识别出的讨论减重手术的障碍包括不确定患者的保险是否会涵盖该手术，或者患者是否符合条件（24.4%比 19.5%）。此外，43.9%的提供者认为减重手术的风险大于收益。
尽管很大比例的患者由 PCP 照顾并被归类为肥胖，但很少有提供者与潜在的合格手术候选者讨论减肥选择。确定的障碍表明有机会改善患者资格的教育，简化对话和转诊的策略，并加强手术减肥的安全性。提供者对这种教育的需求表明有机会通过增加患者对这些话题的讨论，努力减少转诊差距。
