Hlavin, Callie
(2023)
Barriers to Bariatric Surgery: A Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery.
Master Essay, University of Pittsburgh.
Abstract
Morbid obesity has emerged as a major public health concern as rates have skyrocketed over the past few decades. Populations most affected by obesity are not reflected in the patients who seek evaluation for and undergo bariatric or weight loss surgery. This study aims to identify patient populations at risk for attrition during bariatric surgery assessment and determine modifiable barriers to combat access inequality to bariatric surgery. We conducted a single institution, retrospective, mixed methods study investigating the compositional differences between adult patients who achieved or withdrew from bariatric surgery. We collected demographic, socioeconomic, and medical data from the electronic medical record between 2012 and 2021. We then performed computer-assisted self-administered interviews of patients who withdrew from surgery, collecting information on patient knowledge, expectations, and barriers to bariatric surgery. Patients who attained bariatric surgery were more likely to be younger (mean age, 42.2 ± 11.9 vs. 43.8 ± 12.5, p<0.0001), female (82.3 vs. 76.5%, p<0.0001), White (81.2% vs. 75.6%, p=0.0002), married (48.5% vs. 44.1%, p=0.004), and employed full-time (48.2% vs. 43.8%, p=0.01). They were less likely to live in an area with a low-income tract (37.1% vs. 40.7%, p=0.01) or poverty (poverty rate 15.8 ± 15.3 vs. 17.4 ± 16.8, p=0.0002). The surgery group had lower frequency of type 2 diabetes (11.1% vs. 15.6%, p<0.0001), hypertension (29.0% vs. 33.7%, p=0.0003), and current everyday tobacco use (5.4% vs. 12.0%). We received 280 completed surveys for a response rate of 8.9%. Respondents were majority female sex (75.5%) with at least some college education (81.8%) and a household income of $50,000 or greater (61.7%). During their clinic visit, patients gained knowledge about bariatric surgery and the insurance process. Fear of complications, length of the insurance approval process, and wait time between initial evaluation and surgery were the most reported barriers. Clinic patients who undergo surgery are more likely to identify with characteristics of historically privileged communities, which do not reflect communities most affected by obesity. Our results suggest the insurance approval process is a major barrier to bariatric surgery for marginalized populations and should be a focus of future healthcare reform.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
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| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Chair | Courcoulas, Anita | courcoulasap@upmc.edu | UNSPECIFIED | UNSPECIFIED | | Committee Member | Hershey, Tina | tbh16@pitt.edu | tbh16 | UNSPECIFIED |
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| Date: |
5 January 2023 |
| Date Type: |
Completion |
| Submission Date: |
13 December 2022 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
52 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Multidisciplinary MPH |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
bariatric surgery; barriers |
| Date Deposited: |
05 Jan 2023 15:27 |
| Last Modified: |
05 Jan 2024 06:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/43997 |
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