Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons

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. Materials and 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. (c) 2008 Elsevier Inc. All rights reserved.