Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.
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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.
Published Version (Please cite this version)10.1016/j.soard.2015.11.028
Publication InfoFunk, LM; Greenberg, CC; Jolles, SA; Maciejewski, Matthew Leonard; McVay, MA; Safdar, N; ... Whittle, JC (2016). Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study. Surg Obes Relat Dis, 12(4). pp. 893-901. 10.1016/j.soard.2015.11.028. Retrieved from http://hdl.handle.net/10161/12382.
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Professor in Population Health Sciences
Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences. He is also a Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care at the Durham VA Medical Center. Matt also holds Adjunct Professor appointments in the Schools of Public Health and Pharmacy at the University of North Carolina at Chapel Hill. He has research interests in four areas: 1) evaluation of sur
Adjunct Professor in the Department of Medicine
Randomized trials of behavioral interventions; adherence to treatment regimens; spousal support in chronic disease management, mixed research synthesis; measurement of self-reported medication nonadherence
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