GP Referral for Obesity Study

Qualitative study of GP referral of obese patients including referral for bariatric surgery in New South Wales

Background/Rationale

The BEACH study in 2011/12 showed that 26.6% of adult patients presenting in general practice are obese; an increase from 20. 9% in 2002/3 (6).  Options for GP management of patients with obesity without chronic disease are limited.  There has been a recent legal case: A morbidly obese man dying of liver cancer has been awarded more than $350,000 from his doctor because the GP failed to refer him to a weight-loss clinic or send him for lap-band surgery (See media article)

Decision making in primary health care about which obese patients to refer, when and to whom is a critical element in the 5As pathway.  Relatively few overweight or obese patients are referred (<10%) with the decision making being based on patient, provider and referral service factors (1-3).

With the increase in obesity, demand for multidisciplinary services and bariatric surgery is already outstripping supply in the public sector, giving rise to inequality of access based on private health insurance status and income. There is also an unequal distribution of obesity in the community with prevalence rates highest among low socioeconomic groups.   It is also causing increasing financial demands on State Hospitals with a multidisciplinary service for about 250 people costing about $0.5m per year and surgery costing at least $4,000 per procedure.  In NSW in 2010 40% of public bariatric surgery was for secondary procedures following initial bariatric surgery in the private sector.  The public sector also has had to manage patients with long term complications of bariatric surgery.

In 2007–08, over 90% of separations for weight loss surgery were in private hospitals, with private health insurance funding 82% of separation (5).  Separation rates for weight loss surgery were lowest for people living in the most disadvantaged areas of Australia; people living in areas classified in the middle socioeconomic group had the highest separation rate for these procedures.

Aims

To  investigate

  1. the patient, provider and system factors influencing GP decision making about which patients with a BMI >30  to refer and where to refer to
  2. the medical, surgical and allied health referral pathways available to GPs in managing these patients especially disadvantaged or low income patients and GPs perceptions of the outcomes from these.

Design:

Qualitative study involving interviews with GPs

Recruitment

Four Medicare Locals were asked to invite GPs to participate. The aim was to obtain 10 participants per Medicare Local, stratified by practice type (single, group, hospital, with or without a nurse or other supportive staff) and ethnicity to provide a diversity of GPs.

Data collection and analysis

Medicare Locals provided information on local private and public referral options for GPs:

  • Medical specialist services
  • Surgical services
  • Allied health services (weight reduction)

Interviews with GPs were conducted either face to face, or where this is not possible by phone.  Interviews were recorded and transcribed.  Approximate duration of interview 30 minutes.

Reporting

  • Click here for a short summary of the results.
  • Click here for the published article: Kim KK, Yeong L-L, Caterson ID, Harris MF (2015) Analysis of factors influencing general practitioners' decision to refer obese patients in Australia: a qualitative study. BMC Family Practice 16(45) doi:10.1186/s12875-015-0262-5

Contact

For more information please contact Professor Mark Harris: m.f.harris@unsw.edu.au

References

1.            Ampt AJ, Amoroso C, Harris MF, McKenzie SH, Rose VK, Taggart JR.. . Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Pracice. 2009;10:59.

2.            Harris MF, Fanaian M,  Jayasinghe UW, Passey M, McKenzie S, Powell Davies G, Lyle D, Laws R, Schutze H, Wan Q. A cluster randomised controlled trial of vascular risk factor management in general practice. Medical Journal of Australia. 2012;197:387-93.

3.            Passey ME, Laws RA, Jayasinghe UW, Fanaian M, McKenzie S, Powell-Davies G, Lyle D, Harris MF.  . Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial. BMC Health Serv Res. 2012;12:234.

4.            NHMRC. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia. Commonwealth Of Australia; 2013.

5.            AIHW. Weight loss surgery in Australia. . Canberra: AIHW, 2010  Contract No.: Cat. no. HSE 91.

6.            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.