Attitudes of primary care physicians towards bariatric surgery in Switzerland – a free-word association networks analysis

Abstract

Abstract Objective Primary care physicians (PCP) have a major responsibility in identifying patients with obesity eligible for bariatric surgery (BS). The aim was to explore PCPs’ attitudes towards BS in order to map potential barriers of referral. Methods 3526 PCPs in Switzerland were invited to participate in an online survey. PCPs were asked to write the first 5 words coming to their mind about the term “bariatric surgery”. Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Cognitive representation network was constructed based on co-occurrence of associations, using validated data-driven methodology. Results 216 PCPs completed the study. Respondents were aged 55±9.8 years, had an equal gender distribution and practiced mainly in urban setting (Table 1). The majority of PCPs refer either often (31%) or sometimes (41%) patients for BS, while 7% never refer patients to BS, even if eligibility criteria are met. The PCPs’ overall satisfaction with BS was high (88.5%)(Fig. 1). PCPs could be categorized in 3 subgroups based on their cognitive representation of BS: a) indication-focused (most frequent associations: “obesity”, ”diabetes”/most frequent emotion: “worrying”), b) treatment-focused (“gastric bypass”, “weight loss”/“interested”), and c) risk vs. benefit-focused (“complications”, “challenging follow-up”, “success”/“alert”) (Fig. 2&3). There were no relevant demographic or practice related differences between PCPs in the 3 cognitive modules. PCPs with a treatment-focused mindset had a significantly better knowledge of current guidelines on indications of BS (χ2=17.1, P=0.029) and referred in average 5 patients/year, x2 more than PCPs belonging to the other cognitive modules. Conclusion PCPs in Switzerland approve the efficacy of BS, but show reservation to refer eligible patients systematically. PCPs think about BS along 3 cognitive schemes, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confident knowledge of current indications of BS was the only significant factor that distinguished PCPs with a treatment-focused attitude. Strengthening the collaboration in therapeutic decision-making between PCPs and BS centers has the potential to improve access to optimal care for patients with obesity.