title: Barriers in the Approach of Obese Patients Undergoing Bariatric Surgery in Flemish Hospitals.
abstract: BACKGROUND
  Bariatric surgery is associated not only with weight loss and improvement of comorbidities of obesity but also with short and long-term complications. Preoperative screening and lifelong follow-up of these patients are important to optimize the effect of bariatric surgery and minimize complications. The objective of this study was to create an inventory of the current care offered to bariatric patients before and after surgery in Flemish hospitals, Belgium and to identify barriers for optimal care.
  
  
  METHODS
  Semi-structured interviews with healthcare professionals involved in screening and follow-up of bariatric patients in 12 hospitals in Flanders, Belgium were performed. Interviews were transcribed verbatim and analyzed with NVivo 10.0.
  
  
  RESULTS
  In each participating hospital, except one, biochemical screening before and after bariatric surgery was performed, but the extent and timing varied between hospitals. In ten hospitals, a standard multivitamin preparation was started in all patients after surgery, but there was a large variation for timing of initiation and duration between hospitals. The interviewees indicated that the knowledge about appropriate dosage and formulation adjustments after surgery was limited. Most of the performed drug adjustments were due to improvement of comorbidities. In 9 out of 12 hospitals, a multidisciplinary team was involved, but the approach varied widely. Only in 3 out of 12 hospitals, eligibility of patients for bariatric surgery was discussed in team meetings.
  
  
  CONCLUSIONS
  Strategies to implement existing guidelines are required in order to obtain more uniform, interdisciplinary support for bariatric patients, resulting in an increase of efficiency of surgery and improved patient care.
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 521, 3000, Leuven, Belgium. ina.gesquiere@pharm.kuleuven.be.
authors.forename: Ina
authors.initials: I
authors.lastname: Gesquiere
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 921, 3000, Leuven, Belgium. patrick.augustijns@pharm.kuleuven.be.
authors.forename: Patrick
authors.initials: P
authors.lastname: Augustijns
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. matthias.lannoo@uzleuven.be.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lannoo
authors.affiliation: Clinical and Experimental Endocrinology, KU Leuven, O&N 1, Herestraat 49, Box 902, 3000, Leuven, Belgium. christophe.matthys@uzleuven.be.|Department of Endocrinology, University Hospitals Leuven, Leuven, Campus Gasthuisberg, Herestraat 49, Box 7003, 3000, Leuven, Belgium. christophe.matthys@uzleuven.be.
authors.forename: Christophe
authors.initials: C
authors.lastname: Matthys
authors.affiliation: Clinical and Experimental Endocrinology, KU Leuven, O&N 1, Herestraat 49, Box 902, 3000, Leuven, Belgium. bart.vanderschueren@uzleuven.be.|Department of Endocrinology, University Hospitals Leuven, Leuven, Campus Gasthuisberg, Herestraat 49, Box 7003, 3000, Leuven, Belgium. bart.vanderschueren@uzleuven.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Van der Schueren
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 521, 3000, Leuven, Belgium. veerle.foulon@pharm.kuleuven.be.
authors.forename: Veerle
authors.initials: V
authors.lastname: Foulon
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D001530:Belgium / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000601:surgery*; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data*
keywords: Approach; Bariatric surgery; Counseling; Medication; Multidisciplinary team; Nutritional deficiencies; Obesity; Qualitative interviews