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Survey of Perceptions and Educational Needs of Primary Care Providers in Ontario, Canada Regarding Management of Patients with Morbid Obesity

Boris Zevin, MD, PhD, FRCSC, FACS1, Nancy Dalgarno, PhD2, Mary Martin, MSc3, Colleen Grady, DBA3, Linda Chan, MPH2, Robyn Houlden, MD, FRCPC4, Richard Birtwhistle, MD, MSc, FCFP3, Karen Smith, MD, FRCPC5, Rachel Morkem, MSc3, David Barber, MD, CCFP3. 1Department of Surgery, Queen’s University, 2Office of Professional Development and Educational Scholarship, Queen’s University, 3Department of Family Medicine, Queen’s University, 4Department of Medicine, Queen’s University, 5Department of Physical Medicine and Rehabilitation, Queen’s University

Introduction: Five percent of the Canadian population has morbid obesity; however, access to surgical and medical weight loss interventions for these patients remains limited. This study explored the knowledge, experience, perceptions, and educational needs of Primary Care Providers (PCP) in managing patients with morbid obesity and obesity-related comorbidities in primary care settings.  

Methods: We surveyed practicing PCPs, including primary care physicians and nurse practitioners, in the South East Local Health Integration Network in Southeast Ontario, Canada using a 24-question survey. The survey was circulated via mail, fax, email or in-person at events to 591 PCPs. Data was collected between October 2017 and June 2018, and analyzed with SPSS using descriptive statistics.

Results:  One hundred and three participants responded to the survey (17.4%). The majority were primary care physicians (91.8%), followed by nurse practitioners (6.2%) and other primary health care providers (2.0%). Overall, PCPs reported that, on average, 11.6% of their patient population qualifies for bariatric surgery, though the majority (77.0%) reported that they refer fewer than 20% of these patients for weight loss interventions. In terms of satisfaction with the outcome of recommending treatments for patients with morbid obesity, bariatric surgery had the highest reported level of satisfaction (71.9% were satisfied/very satisfied), while the outcome of recommending weight loss diets was among the lowest (18.7% were satisfied/very satisfied). Twenty-two percent of PCPs agreed/strongly agreed that they are hesitant to refer patients for bariatric surgery, and 43.5% and 53.5% agreed/strongly agreed that they were concerned with the risks associated with bariatric surgery and with postoperative surgical complications, respectively. Nearly half (43.4%) strongly agreed/agreed that future treatment of patients with morbid obesity must be based primarily on bariatric surgery with appropriate behavioral and dietary modifications. Nearly all respondents (88.5%) believe there is a need for education of PCPs on bariatric surgery.

Conclusions: Despite an overall perception that bariatric surgery is successful in the treatment of patients with morbid obesity, PCPs continue to under-refer their patients for surgical weight loss interventions.  This appears to be due to a lack of knowledge about and experience with bariatric surgery among PCPs.  Our results can inform the development of continuing professional development programs that support PCP education in management of patients with morbid obesity. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94721

Program Number: P163

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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