Bariatric Times

MAR 2018

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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10 The Medical Student Notebook Bariatric Times • March 2018 who are healthier to undergo surgery. The inverse relationship between greater comorbidities and selection for surgery has also been found in other publically funded systems. 6 Therefore, removing insurance coverage from the equation does not necessarily change who receives bariatric surgery. It is not enough to have a publicly funded system where all patients have theoretical access. As the Canadian article suggests, the rates of desirability for bariatric surgery might be higher at baseline in well-off women, but even given this assumption, more should be done to address the entire population at risk. If surgical procedure rates are to truly represent the affected population, additional measures must be put in place to ensure surgical treatment for those who would like the procedure but might not have geographical or educational access to bariatric surgery resources. Another Canadian study examined the perceptions of patients waiting for bariatric surgery. This study found that patients' experience of access to and wait times for bariatric surgery in Canada were highly influenced by "perceived and experienced socioeconomic, regional, and waitlist prioritization inequities." 7 In 27 in-depth interviews conducted during the study, inequity was identified as a barrier to accessing bariatric surgery, even in the publicly funded system. Participants in the Canadian study identified several factors that would contribute to a better patient experience during the wait time and decrease the perceived inequity. These factors included periodic updates from the surgeon's office regarding their position on the wait list, access to a specialized weight-loss counselor to guide them through the waiting period and the surgery, dietician support, and further information on what to expect after surgery. 7 Even without universal healthcare access, practitioners in the US can begin to implement these changes in their own clinics to improve the patient experience and create an environment that decreases perceived inequity by offering supportive care to each patient. Of course, this strategy does not alter who comes to the clinic in the first place to receive care. But, it might result in higher retention rates of individuals who initially come to the clinic, but would not feel they had adequate social supports to undergo the surgery if the additional resources were not in place. TRENDS IN ACCESS Trends in bariatric access are also important. Since identifying the social determinants impacting bariatric surgery, the community has made progress in expanding access. A study that examined trends in sociodemographic surgery utilization between 1998 and 2007 showed that the proportion of non-white individuals undergoing bariatric surgery significantly increased from 1998 to 2007. 8 In addition, the proportion of individuals in the lowest income quartile increased, while those in the highest income percentile decreased. 8 The researchers concluded that bariatric surgery has become more accessible in recent years, although the populations disproportionately affected by obesity are still under-represented. Another study examined trends in populations admitted for laparoscopic gastric bypass surgery (LGBS) from 2002 to 2008. This study showed that the difference in the use of LGBS between African- American and caucasian patients declined from 2002 to 2008. However, LGBS use still remained significantly lower for African- [R]emoving insurance coverage from the equation does not necessarily change who receives bariatric surgery. It is not enough to have a publicly funded system where all patients have theoretical access.

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