Making do in the absence of specialist support: Exploring healthcare professionals' views, experiences and behaviours around long-term post-bariatric surgery follow-up care in the United Kingdom.

Abstract

Bariatric surgery is an effective treatment for obesity, but long-term can lead to health-related issues. Guidelines highlight the importance of long-term post-bariatric surgery follow-up. However, in the UK, there is currently no specific funding to support the delivery of this care. Our aim was to understand the views and experiences of healthcare professionals (HCPs) around long-term post-bariatric surgery follow-up, and barriers and enablers to care. Semi-structured interviews with HCPs in UK primary care or specialist weight management services were conducted. The topic guide was theoretically informed by the Capability-Opportunity-Motivation-Behaviour model and the Theoretical Domains Framework. Thematic analysis was undertaken. Twenty-six HCPs were interviewed. Three core themes were interpreted: Existing Challenges, Mediating Factors and Future Directions. While there was agreement on the need for long-term support, current provision was variable and hampered by a paucity of referral options. Follow-up care could be contingent upon the patients' surgical pathway and the culture and expertise within the general practitioner surgery. Participants discussed potential ways to improve care, including using technology, adapting approaches used in other chronic conditions, shared care models and harnessing the potential for peer-based support to improve wellbeing and quality of life. Healthcare professionals' views and experiences shared in this study highlight the complex issues associated with long-term bariatric surgery follow-up. The findings will inform future research to design and implement care pathways that are urgently needed to improve service provision for these patients.