Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study

Abstract

SummaryIncreasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed‐method randomized control trial of a 6‐month participatory, team‐based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6‐month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams.

Understanding Implementation of Complex Interventions in Primary Care Teams

“…35,36,37 Most notably, we found ISF's consideration of general team capacity and its impact on an individual's capacity building extremely important. 36,37 Our results illuminate the pathways between knowledge transformation, practice support, and practice delivery (Figure 2). They exemplify pragmatic strategies for achieving sustainable practice change.…”

Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

“…Primary interviews and field notes were revisited to categorize each intervention participant by individual and contextual factors affecting their ability to conduct weight management visits. Factors corresponded to themes identified in our prior qualitative analysis: 24…”

“…A priori, we conducted and reported on a detailed qualitative evaluation to understand the facilitators and barriers affecting the primary outcome measure. 23,24 Here we report the convergent mixed-methods analysis that assesses the extent to which these barriers and facilitators affected the uptake of the intervention by the nurses and their impact on the quantity of obesity visits.…”

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

“…18 Sensitive topics discussed during intervention sessions indicated that this was a safe space for participants to speak candidly about interprofessional teamwork. The data were roughly evenly split between positive and negative work environments.…”