Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults

Abstract

ImportanceMetabolic and bariatric surgery (MBS) is an effective and safe treatment for obesity and its comorbidities, but less than 50% of those who are eligible and referred for MBS complete the procedure. The patient-physician relationship could be a decisive factor in the decision to complete MBS; however, this relationship has not been explored, particularly among racially and ethnically diverse populations.ObjectiveTo examine the association between patient-reported satisfaction with their patient-physician relationship and MBS completion by self-reported racial and ethnic group.Design, Setting, and ParticipantsThis prospective cohort study included 408 patients who were referred to a bariatric surgeon or obesity medicine program between July 24, 2019, and May 19, 2022.ExposurePatient satisfaction with their physician was measured by 7 dimensions (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physician, and accessibility and convenience) using the Patient Satisfaction Questionnaire Short Form.Main Outcomes and MeasuresCompletion status for MBS (yes or no).ResultsA total of 408 patients (mean [SD] age, 47.3 [11.6] years; among 366 with data available, 317 [86.6%] women and 49 [13.4%] men) were included in the study. Of 363 patients with data available on race and ethnicity, 66 were Hispanic/Latinx (18.2%), 136 (37.5%) were non-Hispanic Black, 146 (40.2%) were non-Hispanic White, and 15 (4.1%) were other race or ethnicity. A total of 124 patients (30.4%) completed MBS. Overall, the mean (SD) patient satisfaction score was significantly greater in MBS completers vs noncompleters (3.86 [0.56] vs 3.61 [0.64]; P < .001). Multivariable logistic regression analysis showed technical quality was the most significant factor for MBS completion (adjusted odds ratio [aOR], 1.99 [95% CI, 1.24-3.19]), followed by communication (aOR, 1.78 [95% CI, 1.16-2.72]) and accessibility and convenience (aOR, 1.61 [95% CI, 1.03-2.53]). The interaction between racial and ethnic groups and patient satisfaction was not significant (eg, mean [SD] score for Hispanic/Latinx completers, 3.95 [0.55] vs 3.77 [0.60] for non-Hispanic White completers; P = .46 for interaction).Conclusions and RelevanceThese findings suggest that there is an association between patient satisfaction with the patient-physician relationship and the decision to complete MBS regardless of race and ethnicity. These findings have important implications for strategies to improve the proportion of qualified patients who complete MBS to achieve improved health outcomes.

Factors associated with progression or non‐progression to bariatric surgery in adults: A systematic review

“…Holding private insurance predicted progression to surgery, 37,49,52 while having public insurance was associated with non-progression in samples of African-American and Hispanic patients. 69,70 In addition, participants were deterred from surgery because of insurance denial and complications, 42,54,66 with Xie et al 77 further identifying that more surgery non-completers, relative to completers, were uninsured. Around 50% of the participants in Hlavin et al's38 study also "somewhat" or "strongly agreed" that the insurance process takes too long.…”

“…54,62,63,66 Longer wait times, in terms of time from orientation to multi-disciplinary evaluation and overall wait time to surgery, were further barriers to surgery. 24,32,33,60 Moreover, Xie et al 77 found that surgery completers reported better satisfaction with their patient-physician relationship than noncompleters.…”