title: Analysis of factors influencing general practitioners' decision to refer obese patients in Australia: a qualitative study.
abstract: BACKGROUND
  Referral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study aimed to describe the factors influencing general practitioners' (GPs) referral intentions for their obese patients.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with 24 GPs from four geographically different areas in New South Wales, Australia about the management of their obese patients. A qualitative analysis was applied using inductive thematic analysis.
  
  
  RESULTS
  The predominant factors influencing GPs' referral were their own attitudes and experience, and their patient's motivation. Lifestyle intervention Referrals were usually initiated by GPs and influenced by their patients and the local health system. Referrals to conduct bariatric surgery were frequently initiated by the patient and influenced by GPs' limited previous experience, patients' expectations and ability to pay, as well as professional and legal issues. There was no strong link between referral and the remoteness of areas or the availability of surgical referral services.
  
  
  CONCLUSIONS
  There were differences between GPs reported referral behaviour for lifestyle and surgical interventions. GPs' attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with GPs about the outcomes for their patients when they are referred.
authors.affiliation: Department of Family Medicine, Gachon University Gil Medical Centre, 774beon-gil 21, Namdongdae-ro, Namdong-gu, Incheon, Korea. zaduplum@aim.com.
authors.forename: Kyoung Kon
authors.initials: KK
authors.lastname: Kim
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. lin-lee.yeong@student.unsw.edu.au.
authors.forename: Lin-Lee
authors.initials: LL
authors.lastname: Yeong
authors.affiliation: Boden Institute, University of Sydney, Sydney, Australia. ian.caterson@sydney.edu.au.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Caterson
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. m.f.harris@unsw.edu.au.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D003657:Decision Making; D005260:Female; D058005:General Practitioners; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data*