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PCPs more likely to prescribe drugs, recommend surgery for obesity management
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Primary care physicians are consistently more likely to prescribe antiobesity medications and recommend bariatric surgery for obesity management vs. nurse practitioners and obstetrician-gynecologists, according to recent survey data.
Christine Petrin
“PCPs tend to have higher rates of prescription for pharmacotherapy, referral for bariatric surgery and utilization of [current procedural terminology] codes for obesity counseling,” Christine Petrin, MPH, of Milken Institute School of Public Health at The George Washington University in Washington, D.C., and colleagues wrote. “However, a sizable portion of PCPs still are not prescribing, referring or counseling patients with obesity. PCPs, OB-GYNs and [nurse practitioners] have significant room for improvement in these three areas. Provider training and education is needed to prepare both physicians and [nurse practitioners] to deliver appropriate care to their patients with obesity.”
Petrin and colleagues analyzed data from 1,501 health care providers (PCPs, OB-GYNs and nurse practitioners) who completed an online survey (respondents were 62% men; 66% white; mean age, 47 years). The survey contained 131 questions (eight questions analyzed in this study) related to demographics, medical practice and practices concerning obesity management. Researchers asked survey participants about their practices regarding drug therapy, bariatric surgery and reimbursement coding. Questions included, “What is typically your minimum requirement for prescribing drug therapy for obesity treatment?” “What is typically your minimum requirement for recommending bariatric surgery?” and “What current procedural terminology (CPT) code do you use when dedicating an office visit to weight management or obesity counseling?” Participants were paid $35 to $80 upon completing the survey.
Researchers found that 50% of nurse practitioners and 47% of OB-GYNs did not prescribe pharmacotherapy for obesity management; 26% of PCPs reported prescribing medical therapy for patients with a BMI of at least 30 kg/m² and at least one comorbid condition as the minimum requirement.
Among all respondents, 31% reported not prescribing pharmacotherapy for obesity; 29% reported prescribing pharmacotherapy at higher thresholds than recommended.
“That 60% of respondents report prescribing behavior misaligned with the clinical guidelines provides evidence of significant gaps in knowledge or disregard for the standard of care in obesity pharmacotherapy treatment,” the researchers wrote.
Among nurse practitioners, 30% reported that they would not recommend bariatric surgery vs. 14% for OB-GYNs and 5% for PCPs. Among PCPs, 42% reported coding office visits for obesity management as a general office visit; approximately one-third of OB-GYNs and nurse practitioners reported not coding for obesity visits.
The researchers also found that some provider practices differed by sex. Men were more likely to code for an obesity visit vs. women, and their highest rate of coding was for general office visits (P < .001). Men also were more likely than women to prescribe pharmacotherapy for obesity vs. women (75% vs. 61%) and across each answer choice (P < .001). Men also were more likely to recommend bariatric surgery vs. women (94% vs. 82%), but men were most likely to recommend bariatric surgery for a patient with a BMI of at least 40 kg/m². Women were more likely to recommend bariatric surgery for a patient with a BMI of at least 25 kg/m² and at least one comorbid condition.
BMI status among health care providers also was associated with treatment decisions, according to researchers. Providers with obesity (10%) were the least likely to prescribe drug therapy, whereas providers with underweight were the more likely (58% vs. 79%; P < .001). Providers with obesity also were less likely to recommend bariatric surgery vs. providers with overweight or average weight (16% vs. 8% and 12%, respectively; P < .001).
“As the BMI category of the providers increased, their likelihood to prescribe drug therapy decreased significantly,” the researchers wrote. “This finding aligns with research that suggests providers with a healthy BMI are more likely to engage in weight-loss discussions and provide recommended obesity care to their patients.” – by Regina Schaffer
Disclosure: Novo Nordisk funded the study.
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