A case study of GP attitudes and approaches to referral for obesity - - PowerPoint PPT Presentation

To refer or not to refer? A case study of GP attitudes and approaches to referral for obesity

Lin-Lee YeongA#, Professor Mark HarrisA, Professor Ian CatersonB, Dr Kyoung Kon KimC

A. Centre for Primary Health Care and Equity B. University of Sydney - Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders C. Gachon University of Medicine and Science - Department of Family Medicine # Corresponding author

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Acknowledgements

• COMPaRE-PHC Team
• Professor Mark Harris, Dr Caterson and Dr Kim
• Medicare Locals and General Practitioners

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Introduction

• 26.6% of adult patients in general practice are obese1
• Obesity highest in low SES, Aboriginal and Torres Strait

Islanders, born overseas2

• In 5As, which obese patients to refer, when and to whom is a

critical element3

• Referral for Bariatric Surgery:
• BMI >40kg/m2 or 35 kg/m2 and co-morbidities3
• BMI >30 kg/m2 and poorly controlled T2DM/CVD risk3

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Rationale

Morbidly obese man awarded $364, 372 as GP ruled negligent by not referring him to bariatric surgery6

• GP referrals happen infrequently4-5
• Patients seeking non-surgical options

are not getting referred4-5

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• Explore attitudes of GPs towards referring
• bese patients for bariatric surgery
• Identify current approaches of GPs to manage

disadvantaged, obese patients

Aims

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• Design: Collective Case Study as a part of a study conducted

by COMPaRE-PHC in NSW

• Setting and Participants: 2 GPs in South West Sydney and 2

GPs in Illawarra-Shoalhaven

• Data collected: Semi-structured interviews
• interview questions explored GP experiences with referral,

influencing factors to refer and costs to patients

• Analysis: Thematic qualitative

Methodology

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South West Sydney (SWS) Illawarra-Shoalhaven (IS)

Location

Dr W Dr X Dr Y Dr Z

Age

40-49 40-49 50-59 30-39

Gender

Male Male Female Female

Practice Size

Group e.g 6+ Solo Single Large group

Distance from bariatric surgery

10km 2km 1km 25 km

Ethnicity of patients

Overseas Overseas Australian Australian

Socio-economic Status of patients, % private health insurance

Medium, 10% Medium, 30% High, 60% Medium, 30%

Location of study, yrs in practice, yrs in current practice

Overseas, 23 , 14 Overseas, 10 , 1.5 Australia, 35 , 30 Australia , 11, 5

Language

English & Non-English English & Non-English English English

Demographic Characteristics

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Results

GPs who feel they have limited

• ptions for referral

GPs who feel they have a variety of options for referral

• Frustrated and negative

attitudes

• Less likely to refer
• Only referred patients with

financial means

• Positive attitudes
• More likely to refer and

recommend surgery

• Employed empathy
• Negotiated with the patient
• Prepared patients mentally

and physically

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• Lack of health system resources and cost

Results

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• GPs are less likely to refer patients if they believe cost

is a major barrier

• Changing attitudes about the limitations of cost is

important

• GPs who believe they have more options, are more

likely to refer patients to surgery and help patients move past barriers

Conclusion

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• Make GPs aware of resources available and

encouraging referrals

• Integrated approach where information

from patients, GPs, hospitals and other programs is shared

• Continued research is required

Implications for Policy and Practice

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Take Home Message

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1. Britt H, Miller GC, Henderson J, Charles J, Valenti L, Harrison C, Bayram C, Zhang C, Pollack AJ, O’Halloran J, Pan Y. General practice activity in Australia 2011-12. Sydney: Sydney University Press, 2012. 2. Passey ME, Laws RA, Jayasinghe UW, Fanaian M, McKenzie S, Powell-Davies G, Lyle D, Harris MF. . Predictors

• f primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster

randomised trial. BMC Health Serv Res. 2012;12:234. 3. National Health and Medical Research Council (2013) Clinical practice guidelines for the management of

• verweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and

Medical Research Council. 4. Denney Wilson E, Wan Q, Vagholkar S, Shutze H, Harris MF. Routine assessment and management of lifestyle risk factors in General Practice: Results from two randomised controlled trials" Australian Family Physician 2010; 38: 950-3 5. Harris M. PEP: An intervention to equitably implement guidelines for vascular disease prevention in general

• practice. 2012 Primary Health Care Research Conference. July 18-20 2012, Canberra

6. Aston, H. 2013. Obese man wins $350,000 payout from GP. Retrieved from http://www.smh.com.au/nsw/obese-man-wins-350000-payout-from-gp-20130207-2e0b6.html#ixzz2PRp3lj6x

• n February 10th 2014

References

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lin-lee.yeong@student.unsw.edu.au and

• www. http://compare-phc.unsw.edu.au/

The research reported in this presentation is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing. The information and opinions contained in it do not necessarily reflect the views

• r policy of the Australian Primary Health Care Research Institute or the

Australian Government Department of Health and Ageing.

Further Information

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Questions