L. M. Funk1,2, S. A. Jolles1,2, R. L. Gunter2, C. I. Voils1,2 1William S. Middleton VA,Department Of Surgery,Madison, WI, USA 2University Of Wisconsin-Madison,Department Of Surgery,Madison, WI, USA
Background: Nearly 20% of U.S. Veterans are severely obese, yet less than 0.1% undergo the most effective treatment – bariatric surgery. The aim of our study was to assess perceived barriers to severe obesity care among bariatric surgeons and nutritionists who work with bariatric patients.
Methods: We conducted interviews with 16 providers, including 10 bariatric surgeons and 6 registered dieticians (RD) who provide severe obesity care to Veterans. At least two surgeons from each of the five national regions in the VA system participated. RDs were recruited from VA weight management programs in the Great Lakes Health Care System region. Using a semi-structured interview guide, an interviewer asked providers to describe the preoperative and postoperative processes of care and challenges to providing bariatric surgery care within the VA system. All interviews were audio-recorded and transcribed. A directed approach to content analysis was applied. Emergent themes were identified and finalized through a process of consensus among four coders. Participants also completed a demographic questionnaire upon the completion of each interview.
Results: The mean provider age was 42.1 (SD=9.8) years; 50% were male and 31% were non-white. The average number of years in practice was 13.7 (SD=8.0); 63% had a dual appointment at a University. Five general barriers to care were identified (Table 1): 1) primary care providers not supporting bariatric surgery; 2) difficulty accessing VA bariatric surgery programs; 3) difficulty meeting preoperative requirements (e.g. weight loss and smoking cessation); 4) difficulty coordinating postoperative care; and 5) patient apprehension about making postoperative lifestyle changes. Three facilitators of bariatric surgery care were identified: 1) patient motivation to improve their long-term quality of life; 2) having social support; and 3) utilizing telehealth.
Conclusion: Educating referring providers about bariatric surgery options, expanding availability of bariatric surgery services, and standardizing preoperative criteria across centers may increase access and improve coordination of bariatric surgery care within the VA. Expanded use of telehealth also appears to support provision of bariatric surgery in the VA. Implementation and dissemination strategies focused on these areas will be key if bariatric surgery provision expands within the VA.
