Abstract
Physiological changes to the body from bariatric surgery necessitate lifelong vitamin and mineral supplementation to prevent potential nutritional deficiencies. Presently, there is no consensus on appropriate long-term follow-up in community settings for people who have undergone bariatric surgery. Current UK guidelines recommend annual monitoring of nutritional status, but little else. Semi-structured interviews were carried out with members of a high volume bariatric surgical unit and community pharmacists working in a variety of settings and locations. Data were collected between June and August 2018 and analysed using a thematic analytic framework. Twenty-five participants were recruited. Bariatric staff (n = 9) reported negligible interaction with community pharmacists but felt establishing communication and developing a potential pathway to collaborate, would provide additional support and potentially improved levels of patient compliance. Community pharmacists (n = 16) reported poor knowledge of bariatric surgery, indicating they were unable to routinely identify people who had bariatric surgery, but understood issues with absorption of vitamins. There is evident potential to involve community pharmacists in post-bariatric patient care pathways. Pharmacists possess knowledge of absorption and metabolism of supplements which could be used to actively support people who have had bariatric surgery in their changed physiological status. Education ought to focus on the functional impact of bariatric surgical procedures and interventions and the consequent nutritional recommendations required. Communication between bariatric units and community pharmacies is needed to construct a clear and formalized infrastructure of support, with remuneration for pharmacy specialist expertise agreed to ensure both financial viability and sustainability.
Highlights
The restrictive and malabsorptive effects of bariatric surgical procedures require lifelong vitamin and mineral supplementation to avoid nutrient deficiencies, which can lead to long term pathological change.[1]
Identifying barriers and enablers to develop a service for bariatric patient support
It was difficult for community pharmacists to identify people who had undergone bariatric surgery patients in routine practice, as people did not commonly inform pharmacists that they had undergone bariatric procedures: Unless I ask, or unless patients tell me when I dispense medication, I wouldn't know
Summary
The restrictive and malabsorptive effects of bariatric surgical procedures require lifelong vitamin and mineral supplementation to avoid nutrient deficiencies, which can lead to long term pathological change.[1]. Current guidelines from the National Institute for Health and Care Excellence recommend the need for “at least annual monitoring of nutritional status and appropriate vitamin supplementation according to identifiable need. This is an integral part of post-surgical care in the context of a shared care model of chronic disease management”.2. Effective communication and co-ordination between bariatric surgical units and community settings is pivotal in ensuring pathways are developed and sustained, to provide optimal, ongoing care for bariatric surgical patients who are transitioning through changes in attitude and behaviour towards both their short and long term nutritional needs.[7]
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