Paul Cinara, Friederich Hans-Christoph, Zech Ulrike, Wild Beate
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
DZPG German Centre for Mental Health - Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany.
Int J Obes (Lond). 2025 May 19. doi: 10.1038/s41366-025-01797-3.
Patients undergoing bariatric surgery have complex bio-psycho-social needs which require integrated care. This study aimed to evaluate changes of integrated care needs from pre- to one-year post-surgery and to identify baseline variables associated with integrated care needs at follow-up.
A retrospective cohort study analyzed routinely collected data from a questionnaire-based psychosocial screening conducted prior to evaluation for bariatric surgery and annual follow-up. Integrated care needs were assessed using the INTERMED self-assessment questionnaire (IM-SA), which assesses care needs of four domains (biological, psychological, social, healthcare-related) and identifies patients with case complexity (total score ≥19). Multiple regression analysis examined associations between baseline variables and integrated care needs at follow-up.
Out of 225 patients who were screened and underwent bariatric surgery between June 2020 and June 2022, 117 provided both pre- and one-year postsurgical data (52%) and thus were included in the study. At one-year post-surgery, integrated care needs were reduced (p < 0.001) and the proportion of patients with case complexity decreased (10.3% vs. 24.8%, p < 0.001). IM-SA scores were reduced in all domains - except the social domain. Sick leave (β = 0.172, p = 0.030) and symptoms of anxiety at baseline (β = 0.235, p = 0.018) were associated with integrated care needs at follow-up.
Bio-psycho-social care needs should be evaluated in pre- and post-bariatric surgery care through a structured assessment, social workers included in the multidisciplinary team, and patients offered psychosocial support prior and after surgery. Rethinking the role and training of social workers is essential, along with developing innovative social interventions extending beyond traditional support.
接受减肥手术的患者有复杂的生物 - 心理 - 社会需求，需要综合护理。本研究旨在评估从术前到术后一年综合护理需求的变化，并确定随访时与综合护理需求相关的基线变量。
一项回顾性队列研究分析了在减肥手术评估前和年度随访时基于问卷的心理社会筛查中常规收集的数据。使用INTERMED自我评估问卷（IM - SA）评估综合护理需求，该问卷评估四个领域（生物、心理、社会、医疗保健相关）的护理需求，并识别病例复杂的患者（总分≥19）。多元回归分析检查了基线变量与随访时综合护理需求之间的关联。
在2020年6月至2022年6月期间接受筛查并接受减肥手术的225名患者中，117名提供了术前和术后一年的数据（52%），因此被纳入研究。术后一年，综合护理需求降低（p < 0.001），病例复杂的患者比例下降（10.3%对24.8%，p < 0.001）。除社会领域外，所有领域的IM - SA评分均降低。病假（β = 0.172，p = 0.030）和基线时的焦虑症状（β = 0.235，p = 0.018）与随访时的综合护理需求相关。
应通过结构化评估在减肥手术前后的护理中评估生物 - 心理 - 社会护理需求，多学科团队中纳入社会工作者，并在手术前后为患者提供心理社会支持。重新思考社会工作者的角色和培训至关重要，同时要开发超越传统支持的创新社会干预措施。
