BACKGROUND Despite the increasing obesity prevalence among American adults, relatively few qualified patients proceed to bariatric surgery. Suggested explanations include referral barriers for weight loss management at primary care provider (PCP) visits. This study aims to assess the referral and practice patterns of PCPs treating patients with obesity. Our goal is to understand treatment barriers in order to implement targeted interventions that enhance quality of care. METHODS A 39-question electronic survey was emailed to PCPs at a single academic institution with community physicians. Questions explored providers' demographics, referral patterns, and knowledge of pathophysiologic obesity mechanisms and bariatric surgery qualifications. Frequency and univariate analyses were performed and compared providers' demographics, positions, and BMIs between referring providers and non-referring providers. RESULTS Of 121 surveys distributed, we achieved a 33.9% response rate (n = 41). 78.0% stated that > 15% of their patients in the preceding year were classified as obese. PCPs indicated initiating weight loss management conversations < 50% of the time with 48.8% of patients. Provider-identified barriers to discussing weight loss surgery included being unsure if patient's insurance would cover the procedure or if patients would qualify (24.4% vs. 19.5%). In addition, 43.9% of providers felt that the risks of bariatric surgery outweigh the benefits. CONCLUSION Despite a large percentage of patients cared for by PCPs being classified as obese, few providers initiate discussions on weight loss options with potentially eligible surgical candidates. The barriers identified indicate an opportunity for improved education on patient qualifications, strategies for streamlining conversations and referrals, and reinforcement of the safety of surgical weight loss. Providers' desire for this education demonstrates an opportunity to work toward minimizing the referral gap by increasing patient conversations about these topics.

中文翻译：

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基层医疗服务提供者对减肥手术的态度和知识。

背景技术尽管在美国成年人中肥胖患病率增加，但是相对少数合格的患者进行减肥手术。建议的解释包括在初级保健提供者（PCP）访视时进行减肥管理的转诊障碍。这项研究旨在评估PCP治疗肥胖症患者的转诊和实践模式。我们的目标是了解治疗障碍，以便实施有针对性的干预措施，以提高护理质量。方法将39个问题的电子问卷通过电子邮件发送给一家社区机构的单一学术机构的PCP。问题探讨了提供者的人口统计学，转诊模式以及病理生理性肥胖机制和减肥手术资格的知识。进行了频率和单变量分析，并比较了提供商的人口统计，职位，推荐提供者和非推荐提供者之间的BMI。结果在分发的121个调查中，我们的答复率为33.9％（n = 41）。78.0％的人指出，前一年有超过15％的患者被归类为肥胖。PCPs表示，有48.8％的患者在少于50％的时间内开始进行减肥管理对话。提供者确定的讨论减肥手术的障碍包括不确定患者的保险是否涵盖该程序或患者是否合格（24.4％vs. 19.5％）。此外，有43.9％的医疗服务提供者认为减肥手术的风险大于收益。结论尽管PCP所照顾的患者中有很大一部分被归类为肥胖，但很少有提供者与潜在合格的手术候选人开始讨论减肥方案。所发现的障碍表明，有机会改善对患者资格的教育，简化对话和转诊的策略，并加强手术减肥的安全性。提供者对这种教育的渴望证明了有机会通过增加患者对这些话题的对话来努力减少推荐差距。