Luke M Funk1, Sally A Jolles2, Caprice C Greenberg3, Margaret L Schwarze3, Nasia Safdar4, Megan A McVay5, Jeffrey C Whittle6, Matthew L Maciejewski7, Corrine I Voils7. 1. Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin. Electronic address: funk@surgery.wisc.edu. 2. Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin. 3. Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin. 4. William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin; Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin. 5. Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina; Durham VA Medical Center, Health Services Research & Development, Durham, North Carolina. 6. Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin. 7. Durham VA Medical Center, Health Services Research & Development, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Abstract
BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. METHODS: PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. CONCLUSION: Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. METHODS: PCPs were asked to discuss prioritization of treatment for a severely obesepatient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. CONCLUSION: Decision making by PCPs for severely obesepatients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
Authors: Luke M Funk; Janet M Grubber; Megan A McVay; Maren K Olsen; William S Yancy; Corrine I Voils Journal: Eat Weight Disord Date: 2017-08-29 Impact factor: 4.652
Authors: Eliza A Conaty; Woody Denham; Stephen P Haggerty; John G Linn; Raymond J Joehl; Michael B Ujiki Journal: Obes Surg Date: 2020-02 Impact factor: 4.129
Authors: Luke M Funk; Esra Alagoz; Sally A Jolles; Grace E Shea; Rebecca L Gunter; Susan D Raffa; Corrine I Voils Journal: Ann Surg Date: 2022-01-01 Impact factor: 12.969
Authors: Jacob Nudel; Andrew M Bishara; Susanna W L de Geus; Prasad Patil; Jayakanth Srinivasan; Donald T Hess; Jonathan Woodson Journal: Surg Endosc Date: 2020-01-17 Impact factor: 3.453