Emily K Horecki Lopez, Melissa C Helm, Jon C Gould, Kathleen Lak. Medical College of Wisconsin
Background: Despite increasing obesity prevalence among American adults, relatively few patients who qualify proceed to bariatric surgery. Suggested explanations for this disparity include referral barriers for obesity and weight loss management at primary care provider (PCP) visits. This study aims to assess the referral and practice patterns of PCPs when treating patients suffering from obesity. Our goal is to understand PCP patterns in order to design education programs and interventions to enhance quality treatment available to patients with obesity.
Methods: A 39 question electronic survey was distributed using Qualtrics to PCPs at a single academic institution with community physicians. Questions explored provider demographics, weight loss management referral patterns, and knowledge of pathophysiologic obesity mechanisms and bariatric surgery qualifications. Frequency analyses were performed to determine the number of respondents that chose each answer.
Results: Of the 121 surveys distributed, 41 responded (33.9%). 84.1% stated that >15% of their patients in the preceding year were overweight or obese. 46.3% of providers reported initiating conversations about surgical weight loss <50% of the time. Providers identified insufficient office visit time (24.4%) and lack of office support staff (14.6%) as the most common barriers to initiating weight loss conversations. Barriers to discussing weight loss surgery included being unsure whether patients’ insurance would cover the procedure (24.4%) or whether patients would qualify (19.5%). Providers indicated the biggest obstacles to referring patients for surgical weight loss were lack of patient interest or engagement in obesity management (61.0%) and time restrictions on office visits (14.6%). 35 respondents (85.4%) requested provider education on weight loss management options and 36 (87.8%) were interested in patient targeted handouts to guide these discussions. In assessing provider knowledge about bariatric surgery, 22 (53.7%) providers correctly identified the mortality of Roux-en-Y gastric bypass as 0.1%, while only 13 (34.1%) correctly identified the average excess weight loss after laparoscopic sleeve gastrectomy as 50-60%.
Conclusion: In line with national obesity trends, a large percentage of patients cared for by PCPs are overweight or obese. Despite this, few providers report that they initiate discussions on surgical weight loss options with potentially eligible patients. 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 towards minimizing the referral gap by increasing provider-patient conversations about obesity management and surgical weight loss knowledge.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94492
Program Number: S119
Presentation Session: Bariatric IV – Quality and Outcomes
Presentation Type: Podium