Related Experiment Videos
Public-private differences in bariatric surgery care pathways in Australia: Implications for continuity of care
Sally Badorrek1, Janet Franklin2, Zhenjun Liao3
1Nepean Blue Mountains Family Metabolic Health Service, Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia; Charles Perkins Centre - Nepean Campus, University of Sydney, Derby St, Kingswood, NSW, 2747, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, Science Rd, Camperdown, NSW, 2050, Australia.
Background:
Australian public-private bariatric surgery comparisons have largely focused on access, safety and clinical outcomes, with less evidence describing provider-specific engagement across the perioperative pathway.
Objectives:
To compare pre-operative engagement, provider-specific follow-up, attrition and weight outcomes between public and private bariatric surgery pathways in Australia.
Methods:
This prospective multi-site observational study included adults undergoing bariatric surgery across two public and two private services in New South Wales (2021-2024). Appointment attendance across the perioperative period (12 months pre- to 24 months post-surgery) was analysed. Engagement, attrition and weight outcomes were compared using non-parametric tests, regression analyses and Kaplan-Meier and Cox proportional hazards models.
Results:
Of 240 participants, 176 (73.3%) underwent private and 64 (26.7%) public surgery. Public patients had higher baseline weight, BMI, multimorbidity and greater socioeconomic disadvantage (all p < 0.001). They engaged longer pre-operatively (21.6 vs 2.7 months) and attended more MDT appointments (14 vs 2; both p < 0.001), with greater exposure to non-surgical doctors, dietitians, nurses, psychologists, and exercise professionals. Post-operatively, public patients attended a median of 12 (IQR 9-18) appointments compared to 7 (IQR 5-10) in the private services (p < 0.001) and remained engaged longer (18.2 vs 14.5 months). Attrition occurred later in public patients but was similar by 24 months. No statistically significant differences in relative weight loss were detected beyond 6 months. Surgical setting (B =4.344, p < 0.001) and anticipated support need (B =2.194, p = 0.035) were independently associated with post-operative attendance.
Conclusion:
Follow-up engagement appeared to be associated with surgical setting and anticipated support need, while observed weight loss outcomes were broadly similar between sectors. However, baseline differences and observational design preclude conclusions about the comparative effectiveness of the care pathways.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:26Traditional Level Of Health Care System
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...