Bariatric presurg evals

[erg923]

Long story short: I support the position that there is significant incremental validity/utility to using some standardized instruments/psychological testing data for this purpose. Long list of arguments here I think.....one of which is in a position paper from AMBS.

Another: Psychological Assessment of the Patient Undergoing Bariatric Surgery

“Interestingly, no assessors reported relying solely on the clinical interview for their evaluations. The likely explanation for this finding is that the patient feels tremendous pressure to appear psychologically fit so as to proceed with the surgery. This pressure can lead to the intentional and unintentional distortion of information presented by the patient. The value of objective psychological testing is that the commonly used measures have validity scales that detect when patients present information that is overly favorable.”“Interestingly, no assessors reported relying solely on the clinical interview for their evaluations. The likely explanation for this finding is that the patient feels tremendous pressure to appear psychologically fit so as to proceed with the surgery. This pressure can lead to the intentional and unintentional distortion of information presented by the patient. The value of objective psychological testing is that the commonly used measures have validity scales that detect when patients present information that is overly favorable.”

I would like to hear other data and/or clinically sound arguments for this approach. It's not like we don't this for our health, or for the paltry money from third party payers. Thanks!

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[DrCoal]

We used the Weight and Lifestyle Inventory (WALI) to guide the clinical interview. We threw in a few self report measures for depression and whatnot (its been many years so hard to remember what we used beyond the BDI). Most of what we were looking for was past adherence to a structured eating plan and any glaring mental health issues that may sabotage following an eating plan after surgery. Any hesitation, we offered free behavioral weight loss sessions (which involved a little behavioral weight loss and a lot of general therapy). The surgeons we worked with appeared to appreciate us being the gatekeepers for them. This was at an academic setting so we had the option of offering the behavioral weight loss sessions (usually done by practicum students, interns, and postdocs in conjunction with clinical staff).

 

[iliketohelppeople]

I shadowed clinicians doing these types of evals and other health psych evals (e.g., spinal cord stimulators). They utilized the MDMB. They utilized this for some of the thinking above - it had various validity checks and compared it to similar populations (cannot remember right now if it had norms for specific types of evals - EDIT: It does have specific scoring for Bariatric). An interesting area of assessment - wish I had gotten more training in that.

 

[cara susanna]

We use the VA-recommended protocol, which is a clinical interview and chart review, the MBMD, the Health Locus of Control Scale, the Questionnaire on Eating and Weight Patterns (to rule out eating disordered behavior), the DAST, and the AUDIT-C.

 

[Justanothergrad]

There is a fairly robust and substantial literature base on bariatric surgery candidates / outcomes from Marek to demonstrate incremental utility of it which supports the idea (to me) that it and other instruments with strong psychometric properties are useful in these cases. I mean, its unsurprising to me that assessment instruments help make clinical determinations and it seems wise to incorporate those for better predictive power (see Meehl, 1956). I can't speak to other instruments as this assessment referral is outside my scope, but I have a hard time imagining a reason to believe it is somehow unique from the benefits of testing in a way that other domains and needs are not. Sure, there are issues of valid responding but there are also clinical indications which need consideration. It doesn't matter which way you slice the cake, you need to evaluate both effectively and actuarial methods beat unguided clinical decision making.

 

[psych.meout]

Andrew Block does some really great work with presurgical evaluations.

In this book, Presurgical Psychological Screening: Understanding Patients, Improving Outcomes, he does reference bariatric surgery, but I've not really explored that area. I've done presurgicval evals for chronic pain and, if his bariatric stuff is as good as the pain stuff, I would go with that.

The pain stuff is great. He references specific instruments to use and what scales, if any (e.g., MMPI-2-RF), on them have been shown to have clinical utility, as well as interview and medical record review-based data to use. There's even a great algorithm and visual diagram to illustrate how to use the data.

 

[erg923]

Thanks.

I am working to construct updated policy statements and guidelines for some of our company's state health plans.

Ironically, some of our state health plans auto-approve all psychological testing requests within the context of these evaluations, whereas others are balking at authing even a couple units even when they have been reviewed for medical necessity by physicians or psychologists. All based on the exact same (poorly worded/articulated, outdated, and poorly cited/resourced) medical necessity guideline statement. It's a mess.

 

[LadyHalcyon]

I recently received a PA for a spinalcord stimulator evaluation because Medicare and Medicaid require one; I believe I billed 7 units. We have been receiving more and more of these lately.

Thanks.

I am working to construct updated policy statements and guidelines for some of our company's state health plans.

Ironically, some of our state health plans auto-approve all psychological testing requests within the context of these evaluations, whereas others are balking at authing even a couple units even when they have been reviewed for medical necessity by physicians or psychologists. All based on the exact same (poorly worded/articulated, outdated, and poorly cited/resourced) medical necessity guideline statement. It's a mess.