Factors affecting the referral of primary health care doctors toward bariatric surgery in morbid obesity

Background: Few eligible candidates are referred from primary care for bariatric surgery in spite of improvement in its safety and efficacy. Objective: The aim of this study was to identify factors affecting primary care physicians' (PCPs) referral to bariatric surgery in morbid obesity. Methods: This study is a cross-sectional survey that was conducted at three randomly selected health regions in Kuwait. Primary care physicians were classified according to whether they refer patients to bariatric surgery or not into cases (non-referring) and controls (referring). The participating physicians were family practice physicians (FPs) or general practitioners (GPs). Self-administered questionnaires were distributed to all PCPs currently working in 50 centers in the selected regions. The questionnaire included data on their personal characteristics, their perception and knowledge about the use of bariatric surgery in morbid obesity. Univariate analyses were used followed by multiple logistic analysis to determine factors associated with non-referral to bariatric surgery. Results: The results revealed that the referring physicians were more liable to be females and FPs (OR = 0.5, 95% CI: 0.3-0.9 and OR= 0.5, 95% CI: 0.3-0.8, respectively). Overweight and obese physicians were more liable to be non-referring than those with normal BMI (OR = 1.6, 95% CI: 1.23.3 and OR = 1.2, 95% CI: 1.1-2.8, respectively). Physicians who could not define correctly bariatric surgery for morbid obesity that requires surgery in a patient without or with co-morbidities were more liable to be non-referring (OR = 1.3, 95% CI: 1.2-2.4, OR= 1.4, 95% CI: 1.1-2.9 and OR = 1.8, 95% CI: 1.2-3.6, respectively). Also, non-referring physician didn't know the average percentage of the excess weight that is lost in 5 years after bariatric surgery (OR = 1.4, 95% CI: 1.2-2.4). Conclusion: Training in the referral process should ensure that PCPs obtain the skills necessary to expand their scope of practice, when appropriate and determine when and why a patient should be referred. (C) 2011 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B. V. All rights reserved.