Patient perceptions of primary care providers' knowledge of bariatric surgery

Developing a long-term follow up service for bariatric surgical patients in the community: Patient and professional perspectives

Background

In the UK, bariatric surgical patients are followed up for 2 years post-operatively in hospital settings, before being discharged into General Practice for long-term follow-up. Presently, there is ambiguous guidance as to what should be included in a community-based bariatric surgical follow-up service. The aim of the study was to understand, from both patient and professional perspectives, what is needed to support the long-term management of bariatric surgical patients in community-based settings.

Methods

Post-surgical bariatric patients and General Practice staff were recruited from an area in the UK which has an National Health Service (NHS) hospital providing a high-volume and established bariatric surgical service. Data was collected through semi-structured interviews. A thematic analytic framework was used to construct eight themes which illuminated the participants' experiences. The study took place between March and December 2021.

Findings

Thirty participants (14 patients and 16 healthcare professionals) were recruited to the study. The study revealed the lack of a framework for delivery of a long-term follow up service was frustrating to both patients and professionals. Patient participants reported needing more support, especially dietetic and psychological input, and professionals stated they had little knowledge about bariatric surgical care, and what was needed to provide optimal care, but wanted to provide quality patient care.

Conclusion

Long-term follow up of bariatric surgical patients is an important issue which needs addressing. This study illuminates both the patient and professional perspectives on developing a pragmatic, community-based service which meets the needs of patients and considers the need to incorporate such a service into existing infrastructures without adding additional demands on General Practice.

Impact of bariatric and metabolic surgery education program on the knowledge and attitude of medical students

Objectives

Bariatric and metabolic surgery (BMS) is the most effective treatment method of morbid obesity. Optimum education of medical students regarding BMS is important for proper assessment of morbidly obese patients in the future.

Material and Methods

Medical students from five and six years were determined as the targeted study population. A survey including 17 questions was applied through a web-based survey platform. Students who replied the survey were classified into two groups: distinct bariatric and metabolic surgery education program (BMSEP) (+) and (-). The answers of two groups were compared using Chi-square test.

Results

In total, 845 students replied the survey. Surgery referral rates were higher (33.4% vs. 26.5%, p <0.05), referring to alternative treatment methods were low (4.9% vs. 11.9%, p <0.05), the answer rate of "absolutely agree" was higher and "have no idea" was lower in questions regarding the indications of BMS for the sample patient with body mass index (BMI)> 40 kg/m² and the sample patient with BMI between 35-40 kg/m² in the BMSEP (+) group (p <0.05). However, the two groups were comparable for the answers given for the sample patient of BMI 30-35 kg/m² with uncontrolled diabetes. The rate of first-degree relative referral to BMS when indicated was higher in the BMSEP (+) group. Effectiveness of surgery, cost and risk perception were comparable between the two groups.

Conclusion

This study showed that medical students who have a distinct BMSEP in their medical school have better level of knowledge and comparable risk perception regarding BMS. Structured education programs in BMS may directly improve knowledge, perception, and attitude of medical students and indirectly increase the role of primary care physicians in patient referral to BMS and long-term follow-up.

Turkish primary care physicians’ attitudes and knowledge of obesity and bariatric surgery: a survey study

Objective: This survey study attempted to determine Turkish primary care physicians’ (PCP) knowledge, attitudes, and perceptions of obesity treatment and bariatric surgery. Moreover, the relationship between the duration of practice as a physician, and especially the indications for bariatric surgery and referral to surgery were investigated.

Material and Methods: A survey of 27 questions was administered via social media and the internet using the SurveyMonkey platform. The physicians who responded to the survey were grouped based on the duration of working life. Among these groups, the responses to the questions about bariatric surgery were compared using univariate analysis.

Results: A total of 1044 physicians responded to the survey. The number of physicians who strongly agreed that a PCP should play role in the treatment of obesity was 743 (71.1%). The most important reason for not undertaking this treatment was reported as the requirement for a multidisciplinary approach to obesity treatment (51.5%, n= 537). The percentage of those who thought that patients with a body mass index (BMI) above 40 kg/m2 should be referred to surgery was 72.3%,while the percentage of those referring patients with a BMI of 35-40 kg/m2 and comorbidities to surgery was 53.3%, and the percentage of those referring patients with a BMI of 35-40 kg/m2 and uncontrolled diabetes to surgery was 35.9%. Physicians who were new to the profession were found to evaluate surgical indications more positively (p< 0.05).

Conclusion: This study found that PCPs in Turkey had a basic knowledge of obesity treatment and were willing to treat and follow up these patients. However, it was observed that they could not adequately focus on this issue due to the requirement for a multidisciplinary approach to the disease and the workload. It was found that the young physiciansð level of knowledge of bariatric surgery was higher, but their attitudes towards patient referral were similar.