Primary care physician decision making regarding referral for bariatric surgery: a national survey.
BACKGROUND
Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs).


METHODS
Primary care physicians in Denmark METHODS: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated.


RESULTS
133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national referral criteria for bariatric surgery. With respect to the specific patient cases, a remarkably smaller part of physicians would refer patients on their own initiative, compared with the patient's initiative. Fear of postoperative surgical complications and medical complications both influenced markedly the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future.


CONCLUSIONS
Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might, in part, result in a low rate of referral to bariatric surgery.
Medical Department, Hospital of South West Jutland, Esbjerg, Denmark. Electronic address: Charlotte.roen.stolberg@rsyd.dk.
Charlotte Røn
CR
Stolberg
Medical Department, Hospital of South West Jutland, Esbjerg, Denmark; Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark.
Nicola
N
Hepp
Aarhus University, Århus, Denmark.
Anna Julie Aavild
AJA
Juhl
Department of General Psychiatry, Mental health services in Region of Southern Denmark.
Deepti
D
B C
Medical Department, Hospital of South West Jutland, Esbjerg, Denmark.
Claus B
CB
Juhl
D001291:Attitude of Health Personnel; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
Attitudes; Bariatric Surgery; Obesity treatment; Primary care physicians; Referral patterns; Reservations