A Program to Increase Bariatric Surgery Referrals Through Clinical Practice Guidelines
AbstractObesity has reached epidemic levels in our country. Clear clinical practice guidelines (CPGs) are available that address identification, evaluation, and treatment of overweight and obese adults. These CPGs are based on the best evidence available and include dietary, exercise, behavioral, pharmacologic, and surgical interventions 1. Despite these guidelines and data on the efficacy, safety and technical advances of bariatric surgery 2, 3, the overall attitude of patients and providers toward bariatric surgery is negative 4-10. Although there has been a consistent increase in the number of bariatric surgeries being performed, the numbers are still low compared to the number of obese Americans 11. There is compelling evidence in favor of bariatric surgery as a treatment for morbid obesity, yet few patients are being referred to bariatric surgeons 3. One reason that may be is there is a great deal of misinformation about bariatric surgery and many providers have not read or received education treatment of obesity and on bariatric surgery 4-10. Specifically, referrals from Greater Baltimore Medical Associate (GBMA) providers to the Comprehensive Obesity Management Program (COMP) at Greater Baltimore Medical Center (GBMC) are lower than the national average. The purpose of this capstone project was to develop a program for Greater Baltimore Medical Associate (GBMA) primary care providers on the clinical practice guidelines for the identification, evaluation, and treatment of overweight and obese adults including bariatric surgery. Primary care providers from an existing database were surveyed to develop a list of items to include in the education program. Sixty primary care providers were emailed and sixteen providers responded to the internet survey. The majority of the providers selected six of the eleven items to be included in the program. The program was developed based on these recommendations. The program was piloted in two out of fifteen GBMA practices. The Bariatric Surgery 3 program was advertised to the GBMA providers by email and in a print advertisement in their lounge lunch room. Seven providers attended the program. All of the participants felt the program would improve how they cared for their obese patients and believed that because of the program they were more likely to adhere to the clinical practice guidelines for diagnosis, evaluation and treatment of obesity. Six of seven of the participants felt that the program improved their opinion of bariatric surgery. In addition, all of the participants felt that because of the program they were more likely to refer their obese patients to a bariatric surgeon. Use of current clinical practice guidelines, simple tools and face-to-face meeting with primary care providers may improve the care of obese patients. This program will be replicated at other GBMA practices and should be considered at other practices locations. Future data collection would be helpful to determine if, in fact, the program does improve the care of obese patients, increase the use of clinical practice guidelines and increase appropriate referrals to bariatric surgeons.
Table of ContentsOverview; Background; Current Clinical Practice Guidelines for Obesity; Current Provider Practice in Obesity Treatment; Problem Statement; Purpose of Project; Theoretical Framework; Evidence/Literature Review; Attitudes of Patients and Providers toward Bariatric Surgery; Synopsis of the Findings on Patient and Provider Attitudes; Bariatric Surgery Safety and Efficacy; Insurance Coverage, Cost and Inequality in Bariatric Surgery; Educating Providers on Clinical Practice Guidelines; Synthesis of Literature across All Topics; Methodology and Results; Phase 1; Phase 2; Phase 3; Discussion; Plans for Translation; References; Appendices; Table 1; Table 2; Table 3; Table 4; Table 5; Fig 1; Appendix A; Appendix B; Appendix C; Appendix D; Appendix E; Appendix F; Appendix G; Appendix H; Appendix I.
DescriptionUniversity of Maryland, Baltimore. Doctor of Nursing Practice Scholarly Project
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/945
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