Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada

Abstract

Background Primary care providers (PCPs) are typically the primary contact for patients with obesity seeking medical and surgical weight loss interventions; however, previous studies suggest that fewer than 7% of eligible adult patients are referred to publically funded medical and surgical weight loss interventions (MSWLI). Methods We performed an anonymous survey study between October 2017 and June 2018 to explore the knowledge, experiences, perceptions, and educational needs of PCPs in Southeastern Ontario in managing patients with class II and III obesity. Results Surveys were distributed to 591 PCPs (n = 538 family physicians; n = 53 nurse practitioners) identified as practicing in the Southeastern Ontario and 92 (15.6%) participated. PCPs serving a rural population estimated that 14.2 ± 10.9% of patients would qualify for MSWLI compared to 9.9 ± 8.5% of patients of PCPs serving an urban population (p = .049). Overall, 57.5% of respondents did not feel competent prescribing MSWLI to patients with class II/III obesity, while 69.8% stated they had ‘good’ knowledge of the referral criteria for MSWLI. 22.2% of respondents were hesitant to refer patients for bariatric surgery (BS) due to concerns about postoperative surgical complications and risks associated with surgery. Only 25% of respondents were comfortable providing long-term follow up after BS, and only 39.1% had participated in continuing education on management of patients with class II/III obesity in the past 5 years. Conclusion The majority of PCPs believe there is a need for additional education about MSWLI for patients with class II/III obesity. Future studies are needed to develop and compare the effectiveness of additional education and professional development around risks of contemporary BS, indications to consider referral for MSWLI, management and long-term follow-up of patients after BS.

Evaluation of a Bariatric Monitoring Pass for Primary Care Physicians

“…Additionally, recent studies have shown improvements in BS safety, largely due to the advancements in laparoscopic surgical techniques [ 37 ], which also makes this kind of obesity therapy more popular. In contrast as mentioned above, GPs are concerned over providing long-term care [ 36 ] due to a lack of knowledge [ 38 , 39 ] and missing education programs [ 31 , 40 ]. Educational strategies to address these barriers should target continuous knowledge transfer regarding topics in the long-term treatment after BS.…”

Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity

“…Members of the planning committee included a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, educationalists, and the dean of continuing professional development at the Queen's University. The content of the CPD program was derived from a needs assessment of PCPs in Eastern Ontario 11 and a systematic review of the literature which served as a guide to drawing best practices from the range of pertinent literature. 12 This planning committee collated and deliberated on the results of the systematic literature review, as well as surveys and interviews with primary care providers, and two years of CPD pro-gram needs assessments.…”

A scoping review of obesity education interventions for current and prospective medical professionals in Canada

“…Patients with obesity will likely interact with several healthcare professionals from a variety of disciplines, in addition to their primary care providers [ 8 ]. Unfortunately, studies that have assessed healthcare provider confidence and knowledge about delivering care to patients with obesity show disappointing results such as low self-efficacy to discuss obesity, lack of awareness of referrals for behavioural and psychological therapy, medication or surgery, and biased attitudes towards health behaviours predominantly assuming that their patients are inactive or have poor dietary habits [ [9] , [10] , [11] , [12] ]. In fact, a recent survey of 591 primary care providers in Canada found that more than 50% did not feel comfortable referring their patient to medical or surgical options of care for obesity, and only 25% felt prepared to follow up with a patient who has undergone bariatric surgery [ 10 ].…”

“…Unfortunately, studies that have assessed healthcare provider confidence and knowledge about delivering care to patients with obesity show disappointing results such as low self-efficacy to discuss obesity, lack of awareness of referrals for behavioural and psychological therapy, medication or surgery, and biased attitudes towards health behaviours predominantly assuming that their patients are inactive or have poor dietary habits [ [9] , [10] , [11] , [12] ]. In fact, a recent survey of 591 primary care providers in Canada found that more than 50% did not feel comfortable referring their patient to medical or surgical options of care for obesity, and only 25% felt prepared to follow up with a patient who has undergone bariatric surgery [ 10 ]. Similarly, a survey administered to Canadian undergraduate medical students noted that most felt they are not ready to have weight or obesity management related discussions with their future patients [ 13 ].…”