Système gastro-intestinal et digestif

Abstrait

A Survey of GPS Regarding Current Knowledge and Post-operative Care of Bariatric Surgical Patients

Adams HL, Cairney S, Allport JA, Jaunoo SS

Background: National Institute of Clinical Excellence (NICE) estimates that 257,000 people in England could qualify for and undergo bariatric surgery. Less than 9,000 procedures were carried out in 2010-2011. Primary care is the access point to these services for patients and provides critical support afterwards. For the National Health Service (NHS) to meet the increasing demand for bariatric services, primary care involvement is crucial.

Methods: An anonymous online questionnaire was circulated to General Practitioners (GP) to assess their knowledge of the referral process for bariatric services and post-operative care. GPs throughout the West Midlands, North East, North West and South East of England were invited to answer an electronic questionnaire.

Results: 2417 GPs responded to the questionnaire. 67% thought surgery was appropriate for patients with Body Mass Index (BMI) >35 and related co-morbidities, whereas only 46% thought it appropriate for BMI>50 and lower rates for lower BMIs or the absence of co-morbidities. 49% felt the tiered service delayed surgery while two-thirds supported centralisation of services. 90% of GPs felt ill equipped by current guidelines to manage post-operative patients and only 30% knew of guidelines regarding blood tests. Questions relating to specific post-operative management had a large spread of answers; Liquid diet requirement: 2 weeks 23%, 4 weeks 37%, 8 weeks+ 39%. Appropriate post-operative medication forms: liquid 76%, crushed 34%, chewable 24%, tablet 10%. Free text analysis showed GPs wanted more information about these patients with a preference for detailed discharge summaries, written guidelines and general obesity management study days.

Conclusion: To ensure appropriate patients have access to bariatric services, GPs need further education and guideline dissemination. The majority of GPs felt ill equipped to manage bariatric surgical patients. The importance of detailed plans in discharge letters is clear. GPs would also benefit from post-operative guidelines and overarching obesity study days.