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The KOS BAR program is a model for the healthcare system

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Interview with prof. Mariusz Wylezol, bariatric surgeon.

From December 2021 to December 2024, the KOS BAR program operates: comprehensive care for patients who have undergone bariatric surgery. Professor, you have been operating on obese people for many years; How does the CBS BAR program differ from “conventional” bariatric surgery?

As part of the KOS BAR program, the activities of all 19 centers participating in the pilot were standardized, they all implemented exactly the same program, which increased the patient’s chances of safe and effective treatment.

The KOS BAR program consists of four elements…

The preoperative period is described in detail from the point of view of conducting the necessary research, consultations, as well as rehabilitation, that is, preparing the body for the stress associated with the operation. It also included a key element: preoperative weight loss, as this is one of the main elements of perioperative safety.

Regarding the operational module, the standardization of medical care was based on the so-called ERABS protocol, taking into account all the elements necessary for the safety of the patient. In terms of post-operative care, he ensured patient safety and treatment efficiency by imposing on the centers participating in the pilot a model of mandatory care, but at the same time a duty of care to the patient when emergency intervention was necessary.

In addition, the standardization of all centers made it possible to collectively analyze the results of therapeutic procedures and thereby improve treatment results. We would receive very valuable material with which we could improve our behavior.

This is the difference from a medical point of view….

And from the patients’ point of view?

Firstly, the authority of the Ministry of Health, the authority of the state, somehow guaranteed – by specifying the units participating in the CBS BAR program – that the patient would be sent to a center that met the conditions for safe and effective treatment. . These were the centers most experienced in bariatric treatment. The state, with its authority, guaranteed that treatment would take place in the center created for this purpose. From the point of view of a patient who has decided to undergo surgery, the choice of such a center seems obvious.

According to the program, the patient was guaranteed a first consultation within a month from the date of receipt of the referral. So that he is not put in an endless queue. By giving a referral, he could predict when treatment would begin. Moreover, he knew that the operation had to take place between 3 and 6 months after the decision to proceed with the operation was made. This is very important, including from the point of view of organizing your family and professional life. Moreover, it was not the patient who called the center and asked when the examination, consultation, rehabilitation or operation would take place, but the coordinator of the KOS BAR program took care of all this.

What do you see as the most important benefits of the KOS BAR program?

Guarantee that the patient will end up in a very good center and not in a random place, standardization of centers, procedures throughout the country in accordance with the established standard, high level of safety, comprehensive care, including also psychological support, nutrition education, pre- and post-operative rehabilitation, specific dates for the start of treatment, preparation for surgery, and the operation itself. The patient already knew the entire plan when he joined the program – this makes a huge difference: he knew from the very beginning what the treatment, surgery, rehabilitation and examinations would look like.

The program is designed until the end of 2024, there are no official results yet, but do you see from patients that the effect is better?

We are well aware of the positive benefits of bariatric surgery – they are documented in scientific research. Bariatric surgery saves the lives of obese patients. The beneficial effect in the form of disappearance of obesity complications is due not only to weight loss, but also to the effect of bariatric surgery on numerous metabolic processes in the body, for example, on the course of type 2 diabetes. Keep in mind other important aspects of this treatment: 1/3 of the women we operate on are referred by gynecologists because they are unable to get pregnant due to polycystic ovary syndrome. They can have children after surgery. Surgery is an element of a woman’s reproductive health. I am even the godfather of three children born after bariatric surgery.

When it comes to the KOS BAR program, I see the biggest positives in the efficiency of patient care and the use of our public health resources, where the government payer often incurs enormous costs due to increased consultations and testing. Very often we conduct tests that show few results. Example: Ultrasound shows a liver lesion with a diameter of 0.5 cm – CT is recommended. In the description of the tomography, we read that the change has not been confirmed by ultrasound, but MRI should be considered. MRI result: a clear assessment of the nature of the changes, difficult to determine. We can still do a PET scan, then a colonoscopy, gastroscopy, and then repeat the tests, because a year has passed since the first ultrasound. And nothing comes of it. The KOS BAR program, based on the principle of Value Based Healthcare, was aimed at efficient use of public health resources: both the patient and the care team knew exactly what would happen. Everything was standardized, which meant that healthcare resources were not wasted.

I have no doubt that all healthcare should be organized according to the principle of the KOS BAR program. The center must receive funds for patient care in exchange for specific results. Instead of conducting tests and consultations, which often lead nowhere. Any healthcare system would go bankrupt if it relied on procedures. And our system today is based on procedures, not on the effects of treatment.

What can be improved in KOS BAR?

This was a reserve, but there were situations when the patient was 90 percent prepared for the operation, and then gave up: he stopped answering phone calls, did not come to appointments. I believe that this should be a partnership from the very beginning: the center caring for the patient has an obligation to provide quality services, but the patient also has obligations. The KOS BAR program is organized in such a way that the center receives funds from the National Health Fund for the implementation of individual modules. When we gave the patient all the tests and consultations, and he refused to participate at the last minute, the center did not receive any compensation. Of course, this question concerned maybe 1-2 percent. sick, but on a national scale this is a significant number. The program also made it possible to notice that the health problem in Poland concerns not only treatment centers, but also patients.

But the most important thing is that the program continues. And you often talk about the program not “is”, but “was”…

The entire community knew we were talking about a pilot program, but none of us realized that a situation could arise where the program would be implemented, run great for two years, and suddenly be suspended: with no concrete idea of ​​what would happen. happen.

We receive many calls from patients with questions about the program, but we are not yet able to include them in it. The program currently only provides post-operative care for people who have had surgery – it will run until the end of this year. We are unable to admit additional patients into the program, prepare them for surgery, or perform surgery under KOS BAR. The program continues, but only in the area of ​​post-operative care.

However, the program is praised by representatives of the ministry, the National Health Fund, experts and patients. There are still promises that it will continue.

I hope so. The program placed very high organizational demands on medical institutions – they made great organizational and financial efforts to adapt to this model. Uncertainty means that we don’t really know what to do. Our hospital performs bariatric surgery under an agreement with the National Health Fund and not under the KOS BAR program. Of course, none of us will leave a patient without attention, but our general surgery clinic accepts a wide range of patients. Obesity is a huge public health problem; I believe that in an area so important to saving patients’ lives, there should be a standardized program with high organizational requirements to make the best use of health care resources.

I am concerned about the current situation; I’m afraid that what we have achieved will be wasted. If there is no decision to continue the program for several months, some hospitals may decide to eliminate the solutions administered and then not risk it again. Our situation is similar to that of today we abruptly abandoned the DILO card. Or suddenly stop funding prostate cancer surgery using a surgical robot that was recently introduced. Let’s not waste what we have achieved.

Prof. Mariusz Wylezhol
– Head of the Warsaw Comprehensive Center for the Treatment of Obesity and Bariatric Surgery, elected President of the Polish Society for the Treatment of Obesity

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Source: Wprost

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