William S. Middleton VA Memorial Hospital, Madison, Wisconsin.
Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Ann Surg. 2022 Jan 1;275(1):e181-e188. doi: 10.1097/SLA.0000000000003982.
To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers.
Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration.
We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use.
Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time.
Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.
从重度肥胖退伍军人和肥胖症护理提供者的角度描述减重手术的系统障碍。
减重手术是治疗重度肥胖退伍军人的最有效减肥方法，但只有不到 0.1%的重度肥胖退伍军人接受了手术。解决减重手术和体重管理服务利用率低的问题是退伍军人健康管理局的优先事项。
我们对接受过或正在接受减重手术的重度肥胖退伍军人以及为重度肥胖退伍军人提供护理的提供者（包括减重外科医生、初级保健提供者、注册营养师和健康心理学家）进行了半结构化访谈。我们要求研究参与者描述他们在退伍军人事务部系统中接受减重手术的经历。所有访谈均进行了录音和转录。四位编码员迭代开发了一个代码本，并使用常规内容分析来确定 Andersen 行为健康服务使用模型内的相关系统或“背景”障碍。
在退伍军人事务部系统中完成了 73 次与退伍军人（n=33）和提供者（n=40）的半结构化访谈。超过四分之三的退伍军人是男性，而近四分之三的提供者是女性。八个主题被映射到 Andersen 模型上，作为减重手术的障碍：护理协调不善、缺乏减重手术指南、初级保健提供者和转诊提供者对减重手术的知识有限、长途旅行、延迟转诊、获取健康食品的机会有限、难以满足术前要求以及缺乏提供者的可用性和/或时间。
通过改善护理协调和标准化减重手术护理的某些方面来解决系统障碍，可能会提高退伍军人事务部内获得循证严重肥胖症护理的机会。
