Missing an opportunity: the embedded nature of weight management in primary care

Abstract

SummaryThe 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6‐month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi‐structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals.

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).…”

“…35 Using NVIVO 10 software for data management, the material was inductively coded. Each code was then reviewed for recurrent patterns or subthemes, which were compared between codes to identify themes.…”

“…32,33 The study protocol, intervention design, qualitative and quantitative evaluation outcomes, created tools, and intervention materials are described elsewhere. 31,32,34,35 Ethics approval was given by the University of Alberta Health Research Ethics Board-Health Panel (Pro00036740). This trial was registered via Clinical Trials.…”

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

“…This is particularly important given the finding that obesity management is embedded within other reasons for clinical encounters in primary care. 21 Literature focusing on improving providers' clinical practice in obesity management is scant, 4,22 which makes comparison of our core findings difficult. The few studies that assessed provider-level interventions focused on patient outcomes, specifically the amount of weight loss achieved, rather than on the process of provider change.…”

Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health

“…This study is part of the 5As Team (5AsT) research program which partners with a primary care organization (Primary Care Network, PCN), healthcare providers, and patients to transform obesity prevention and management (18)(19)(20)(21). It builds on our previous research showing that providers want to improve care for patients with obesity, and that patients want personalized, evidence-based discussions with their family doctors and teams (3,22).…”