Attitudes, knowledge and referral patterns of PCPS to bariatric surgeons

Abstract

As the prevalence of both severe obesity (BMI >40kg/m2) and its surgical treatment continue to rise, primary care physicians will more frequently evaluate, refer and oversee the long-term medical management of bariatric patients. A cross-sectional mail survey was conducted to assess the attitudes, knowledge and current bariatric referral practices among the family and internal medicine physicians in North Carolina. The effect of demographic and aforementioned factors on PCP referral practices were evaluated using Pearson’s chi-square, Student’s t-test and ANOVA. Forty-seven percent of 611 randomly chosen PCPs returned a self-completed questionnaire. Over 85% (221) of PCPs have provided medical care to operated bariatric patients within the last year and 76% (203) have referred patients to a bariatric surgeon for evaluation. Thirty-five percent of practitioners did not feel they had adequate resources to provide good quality long-term medical care to operated patients and just 45% of physicians felt they were competent to address the medical complications of bariatric surgery. Compared to non-referring PCPs, referring physicians were found to have recently provided medical care to a greater number of severely obese (mean 9.9 vs 7.5, p< 0.001) and post-operative bariatric patients (mean 4.6 and 2.3, p<0.001). Referring providers were also significantly younger (46 vs. 49, p=0.02), had a higher BMI (25.3 vs. 23.5, p=0.001), were more likely to be familiar with NIH guidelines (14.7% vs. 3.0%, p=0.02) and have completed continuing medical education regarding bariatric surgery (49.8% vs. 34.9%, p=0.03) than non-referring physicians. Finally, referring providers were more likely to feel they had adequate resources (71.4% vs. 35.4%, p<0.001) and were competent to provide good quality long-term care to post-operative bariatric patients (54.2% vs. 15.4%, p<0.001). Inter-professional cooperation and education between bariatric surgeons and PCPs are important to ensure appropriate referrals and good quality post-operative care for bariatric patients. Tailored letters and electronic educational resources provided by bariatric surgeons may facilitate optimal outcomes for bariatric patients.