title: Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons.
abstract: BACKGROUND
  As severe obesity (BMI >40kg/m(2)) and its surgical treatment rise, primary care physicians (PCPs) will more frequently evaluate, refer, and oversee the long-term medical management of bariatric patients. A cross-sectional mail survey was conducted to assess the attitudes, knowledge, and bariatric referral practices among family and internal medicine physicians in North Carolina.
  
  
  METHODS
  Forty-seven percent of 611 randomly chosen PCPs returned a self-completed questionnaire. The effect of demographics, PCP attitudes, and PCP knowledge on referral practices was evaluated.
  
  
  RESULTS
  Over 85% (221) of PCPs have treated operated bariatric patients within the last year and 76% (203) have referred patients for surgical evaluation. Thirty-five percent of practitioners felt unprepared to provide good quality long-term medical care to operated patients, and just 45% felt competent to address medical complications of bariatric surgery. Compared with nonreferring PCPs, referring physicians provided medical care to a greater number of severely obese (mean 9.9 versus 7.5, P < 0.001) and postoperative (mean 4.6 and 2.3, P < 0.001) bariatric patients. Referring providers were younger (46 versus 49, P = 0.02), had higher BMI (25.3 versus 23.5, P = 0.001), were more familiar with NIH guidelines (14.7% versus 3.0%, P = 0.02), and had completed more bariatric continuing medical education (49.8% versus 34.9%, P = 0.03). Also, they reported better resources (71.4% versus 35.4%, P < 0.001) and competency to provide good quality long-term care to postoperative bariatric patients (54.2% versus 15.4%, P < 0.001) than nonreferring peers.
  
  
  CONCLUSIONS
  Bariatric surgeons will optimize referrals and postoperative care for patients by working cooperatively with PCPs and by providing educational resources.
authors.affiliation: Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7081, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Balduf
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D011177:Postal Service; D011183:Postoperative Complications / Q000628:therapy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires