Department of Clinical Sciences in Malmö, Lund University, Internal Medicine Research Group, Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502, Malmö, Sweden.
Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
BMC Endocr Disord. 2021 Apr 8;21(1):62. doi: 10.1186/s12902-021-00723-8.
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.
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.
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).
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.
肥胖症的患病率在全球范围内呈上升趋势。减重手术是治疗严重和复杂肥胖症的有效方法，可显著持续减重。在瑞典，大多数接受减重手术的患者都是由初级保健医生转介的。我们旨在探讨医生在为严重和复杂肥胖症患者转介减重手术时面临的障碍。
2019 年，我们向瑞典斯科讷和卡尔马地区的 1100 名初级保健医生发送了一份问卷调查，重点关注转介模式、对减重手术的了解和态度以及对术后并发症的担忧。我们为转介模式、对减重手术的了解、态度和对术后并发症的担忧创建了不同的统计指标。为了分析这些指标之间的相关性，我们进行了 Spearman 相关分析和回归分析。
在 1100 名回复电子邮件的医生中，我们收到了 157 份（14%）完整的调查问卷。在 157 名医生受访者中，73%的人表示对减重手术的转介标准有很好的了解，而 55%和 60%的人正确回答了两个关于减重手术标准的问题。大多数受访者（84%）表示他们的患者主动要求进行减重手术转介。一半的受访者对术后的医疗和手术并发症表示担忧，但另一半对减重手术作为肥胖症合并症的治疗方法持积极态度。近一半的受访者（44%）表示他们需要更多地了解减重手术。我们发现，高知识水平与转介模式（r=0.292，p<0.001）和积极态度（r=0.235，p<0.001）之间存在显著的正相关关系。我们还发现，担忧与转介模式（r=-0.355，p<0.001）和积极态度与担忧（r=-0.294，p<0.001）之间存在显著的负相关关系。在逻辑回归中，高水平的担忧解释了不愿意为减重手术转介的原因（优势比 0.2，95%置信区间 0.1-0.7）。
根据这项针对瑞典初级保健医生的调查，医生对减重手术的高度担忧似乎是阻碍为严重和复杂肥胖症患者转介减重手术的一个因素。由于对肥胖症和减重手术的了解与担忧呈负相关，与对减重手术的积极态度呈正相关，因此需要更多地了解肥胖症和减重手术。
