Abstract
Background: Bariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks.
Aim: To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, post-specialist discharge.
Design and setting: Retrospective cohort study. Primary care practices contributing to IQVIA Medical Research Data (IMRD)–UK (1/1/2000-17/1/2018).
Methods: Participants were adults who had had bariatric surgery with a minimum of three years’ follow-up post-surgery as this study focused on patients discharged from specialist care (at 2yrs post-surgery). Outcomes were annual proportion of patients from 2yrs post-surgery with a record of recommended nutritional screening blood tests, weight measurement and prescription of nutritional supplements, and proportions with nutritional deficiencies based on blood tests.
Results: 3137 participants were included and median follow-up post-surgery was 5.7 (4.2-7.6) years. 45-59% had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, e.g. recorded haemoglobin measurement varied between 44.9% (n=629/1400) and 61.2% (n=653/1067). Annual proportions of blood tests specific to bariatric surgery were low, e.g. recorded copper measurement varied between 1.2% (n=10/818) and 1.5% (n=16/1067) (where recommended). Results indicated that the most common deficiency was anemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low.
Conclusions: Our study suggests that bariatric surgery patients are not receiving recommended nutritional monitoring post-specialist discharge. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand reasons underpinning our findings.
Aim: To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, post-specialist discharge.
Design and setting: Retrospective cohort study. Primary care practices contributing to IQVIA Medical Research Data (IMRD)–UK (1/1/2000-17/1/2018).
Methods: Participants were adults who had had bariatric surgery with a minimum of three years’ follow-up post-surgery as this study focused on patients discharged from specialist care (at 2yrs post-surgery). Outcomes were annual proportion of patients from 2yrs post-surgery with a record of recommended nutritional screening blood tests, weight measurement and prescription of nutritional supplements, and proportions with nutritional deficiencies based on blood tests.
Results: 3137 participants were included and median follow-up post-surgery was 5.7 (4.2-7.6) years. 45-59% had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, e.g. recorded haemoglobin measurement varied between 44.9% (n=629/1400) and 61.2% (n=653/1067). Annual proportions of blood tests specific to bariatric surgery were low, e.g. recorded copper measurement varied between 1.2% (n=10/818) and 1.5% (n=16/1067) (where recommended). Results indicated that the most common deficiency was anemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low.
Conclusions: Our study suggests that bariatric surgery patients are not receiving recommended nutritional monitoring post-specialist discharge. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand reasons underpinning our findings.
| Original language | English |
|---|---|
| Pages (from-to) | 1-23 |
| Journal | British Journal of General Practice |
| Volume | 2020 |
| Issue number | 00 |
| DOIs | |
| Publication status | Published - 9 Dec 2020 |
Bibliographical note
Funding:This study was funded by the National Institute for Health Research (NIHR) Clinical Research Network West Midlands. HMP was funded by the NIHR (Academic Clinical Lectureship) during this work, AAT was funded by the NIHR (Research Clinician Scientist) during this work and SA is funded by the NIHR (ICA- Pre-Doctoral Clinical Academic Fellowship). This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care, the University of East Anglia or the University of Birmingham. The writing of the report and the decision to submit the article for publication rested with the authors from the University of East Anglia and University of Birmingham.
Keywords
- Mental health
- Drug and substance abuse
- Patient groups
- Mens health
- Inequalities
- Education and standards
- Undergraduate education
