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Zoabi E, Elran-Barak R, Sakran N, Sandler NK, Hatoum OA, Kaplan U. Factors Influencing Referral for Bariatric Surgery by Primary Care Physicians in Northern Israel. Obes Surg 2024; 34:2431-2437. [PMID: 38722474 PMCID: PMC11217136 DOI: 10.1007/s11695-024-07253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Obesity is a chronic metabolic disease with global distribution among adults and children which affects daily functioning and ultimately quality of life. Primary care physicians (PCPs) provide an important role for the treatment of severe obesity. Better understanding of obesity and its treatment options may increase patients' referral rates to the various treatment modalities, including metabolic/bariatric surgery (MBS). MATERIALS AND METHODS A quantitative cross-sectional study used a self-reported questionnaire among PCPs of Clalit Health Services (CHS) in Northern Israel. The quantitative questionnaire examined the PCP's knowledge, opinions, attitude, and approaches to managing severe obesity. RESULTS A total of 246 PCPs from Northern Israel filled the questionnaire (42.9%), the majority were Muslim Arabs (54.5%), who gained their medical degree outside of Israel (73.8%) and practicing for over 10 years (58.8%). 64.3% of PCPs had a high workload (over 100 appointments per week), 77.1% did not know the definition of severe obesity, and 69.17% did not attend educational meetings regarding obesity during the previous year. The referral rate for MBS was 50.4% ± 23.3. Two prognostic factors that had a statistically significant effect on the referral rate for bariatric surgery were the total appointments per week, and the number of practice years. Both had a negative association. CONCLUSION The knowledge and referral rates for bariatric surgery are higher among PCPs with lower workload and relatively fewer practice years. Workshops and annual training courses may fortify knowledge and awareness for the treatment of obesity, which in turn could increase the referral rate for MBS.
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Affiliation(s)
- Elham Zoabi
- School of Public Health, University of Haifa, 3103301, Haifa, Israel
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Roni Elran-Barak
- School of Public Health, University of Haifa, 3103301, Haifa, Israel
| | - Nasser Sakran
- Department of General Surgery, Holy Family Hospital, 1623409, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, 1311502, Ramat Gan, Israel
| | - Noga Kaftori Sandler
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Ossama Abu Hatoum
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 3109601, Haifa, Israel
| | - Uri Kaplan
- Department of General Surgery B, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 3109601, Haifa, Israel.
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Ghusn W, Mosleh KA, Hage K, Salame M, Gala K, Edwards MA, Kindel TL, Ghanem OM. A comprehensive analysis of health care Inequities in randomized clinical trials following bariatric surgeries. Am J Surg 2024:115796. [PMID: 38871550 DOI: 10.1016/j.amjsurg.2024.115796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Obesity is a global epidemic, leading to an increasing focus on interventions like bariatric surgeries. Despite this, there's a noticeable gap in understanding the demographic distribution of patients in clinical trials for bariatric surgery. METHODS We conducted a comprehensive analysis of 117 registered randomized clinical trials related to bariatric surgery on ClinicalTrials.gov. We extracted demographic information, including age, sex, race, and ethnicity, and performed descriptive statistical analyses. RESULTS The analysis covered 8,418 participants. The mean age was 43.8 years, with a substantial majority (93.8 %) falling within the 18-65 age group. Females comprised 74.9 % of participants, surpassing real-world estimates. Racially, 65.3 % of participants were White, while African Americans represented 18.5 %, Asians 1.2 %, Native Hawaiians 0.2 %, and American Indians 0.1 %, indicating an underrepresentation of diverse racial groups, notably lower compared to real-world demographic data. In terms of ethnicity, only 17.6 % were Hispanic. CONCLUSIONS This study reveals significant demographic disparities in patients undergoing bariatric surgeries in clinical trials. This suggests a lack of generalizability, emphasizing the need for inclusive recruitment strategies to enhance health equity.
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Affiliation(s)
- Wissam Ghusn
- Department of Internal Medicine, Boston Medical Center, Boston, MA, 02118, USA; Division of Gastroenterology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Marita Salame
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Khushboo Gala
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Michael A Edwards
- Advanced GI and Bariatric Surgery Division, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Myneni AA, Simmonds I, Orom H, Anderson LM, Singh R, Homish GG, Wright AJ, Pigott S, Onoh JC, Hoffman AB, Noyes K. A qualitative analysis of Black men's attitudes toward obesity and bariatric surgery. Surg Obes Relat Dis 2023; 19:1100-1108. [PMID: 37147204 DOI: 10.1016/j.soard.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a safe and highly effective treatment for morbid obesity and related co-morbidities. While MBS access and insurance coverage have greatly improved, sex and racial disparities remain in utilization of MBS. OBJECTIVE To identify novel intrinsic factors that may explain Black underutilization of surgical treatments for weight management. SETTING This study was conducted in metropolitan communities of Western New York. METHODS We conducted semistructured face-to-face interviews with 27 adult Black men with a history of obesity and at least 2 obesity-related conditions (diabetes, hypertension, and/or chronic kidney disease [CKD]), about their attitudes, beliefs, behaviors, and habits related to obesity and obesity management. Interview transcripts were reviewed using thematic analysis for patterns and themes. RESULTS Most participants did not perceive obesity as a serious health condition and those who had weight-loss goals did not aim for a healthy body mass index (BMI). Trust and respectful communication with physician were very important in making healthcare decisions. MBS was perceived as extreme and dangerous option for weight loss, and only participants with severe symptoms such as chronic pain were open to discussing MBS with their providers. Participants acknowledged lack of role models of similar background who had successfully undergone MBS for obesity. CONCLUSIONS This study identified misinformation about risks and benefits of MBS and lack of community role models as important factors contributing to Black men's unwillingness to consider MBS. Further research is needed to facilitate patient-provider communication about weight and improve provider's ability and motivation for weight management in primary care settings.
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Affiliation(s)
- Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Iman Simmonds
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | | | - Ranjit Singh
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Alexander J Wright
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Sydney Pigott
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Joshua C Onoh
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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Zevin B. Comment on: Attitudes of primary care physicians towards bariatric surgery: a free word association networks analysis. Surg Obes Relat Dis 2023; 19:1186-1187. [PMID: 37550164 DOI: 10.1016/j.soard.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Zevin B, Morkem R, Soleas E, Dalgarno N, Barber D. Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:104-108. [PMID: 37249343 DOI: 10.1097/ceh.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI. METHODS A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data. RESULTS Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program. DISCUSSION The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.
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Affiliation(s)
- Boris Zevin
- Dr. Zevin: Associate Professor, Department of Surgery, Queen's University, Kingston, Ontario. Ms. Morkem: Research Associate, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario. Dr. Soleas: Director of Continuing Professional Development and Adjunct Assistant Professor, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario. Dr. Dalgarno: Director of Education Research and Adjunct Assistant Professor, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario. Dr. Barber: Network Director and Assistant Professor, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario
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