Pitfalls of bariatric surgical practice: What not to do. Jeff Hamdorf

Transcription

1 Pitfalls of bariatric surgical practice: What not to do Jeff Hamdorf

2 Pearls and Pitfalls Longevity of bariatric surgery Public vs private Practice Structure Team support Patient information/support Building a referral base Not addressing Public practice Business structures Data bases Practice software

3 The Future of bariatric and metabolic surgery

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5 Asia Pacific trending Obes Surg 2018

6 Practice Structure - Team approach essential Surgeon with outsourcing or Within your own facility

7 Team Care who needs to be in your facility Surgeon Physician Dietitian Psychologist Bariatric nurse Exercise physiologist How often do you (need to) meet?

8 (Try to) convene 6 mo Half day Off site Add in social event Clinical Summit Patient Support App Practice Overview Our Practice: Vision for the Future VIP: User define fields (UDFs) for fun and profit On line patient registration Exercise Physiology overview and results Psychological predictors of success (5 years out) Physical Activity Following Bariatric Surgery Longer term patient follow up study RB Nebula Health Claire Smith Jeff Hamdorf Sue Taylor Mike Devine Claire Reynolds Juliana Zabatiero Clare Tancabel Calcium/PTH for Newbies Literature Overview 5 years of Psych support What does this mean for us? Unique case: Bariatric surgery in situs inversus How old is too old? The elderly bariatric patient Mike D Arcy-Evans Carol Rolston Melanie Greenfeld Angela Burvill Ruth Blackham Evaluation and Close Jeff Hamdorf

9 Accommodating the team

10 Investing in some tech Simple scales vs body comp vs DEXA Body Composition - bioelectrical impedance DEXA - dual X-ray absorptiometry 5. Ashwell M, et al. Waist to height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Obesity reviews Browning LM, et al. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: Nutrition research reviews. 2010

11 A Complete Package? Structured appointments? Follow up techniques Patient Brochures Information Nights Referring Doctor Education Patient Support Groups On line vs supported physical

12 Structured appointments

13 Patient information

14 Social media/web presence

15 Public Information Seminars Advertise to your market Newspapers, Magazines Brochures Health/wellbeing exhibitions Groups of encourage individual questions, interaction and personal involvement. Larger groups allow some anonymity Audiovisual presentation Cover same ground as brochure, but in more detail Does not replace individual counselling

16 Referring Doctor Education/Recruitment Building a referral base

17 Referring Doctor Education/Recruitment Like a patient info session with bigger words and more statistics Use existing forum - GP CME, Pharmaceutical dinners Consider applying for CME accreditation Consider GP information leaflet, or referral pad Allow plenty of time for discussion Get feedback - formal and informal Emphasise team approach Refreshments?

18 Referring Doctor Education/Recruitment Like a patient info session with bigger words and more statistics Use existing forum - GP CME, Pharmaceutical dinners Consider applying for CME accreditation Consider GP information leaflet, or referral pad Allow plenty of time for discussion Get feedback - formal and informal Emphasise team approach Refreshments? Be very wary of offering refreshments

19 Summary Longevity of bariatric surgery Public vs private Practice Structure Team support Patient information/support Building a referral base