Abstract
BackgroundHealth optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. There is little evidence about their impact and the experience of their use. The aim of this study was to investigate the experiences and perspectives of commissioners, clinicians and patients involved in a locality’s health optimisation programme in the United Kingdom. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral.Methods A thematic analysis of semi-structured interviews (n = 20) with National Health Service and Local Authority commissioners and planners, healthcare professionals, and patients using the pathway.ResultsHealth optimisation was broadly acceptable to professionals and patients in our sample and offered a chance to trigger both short term pre-surgical weight loss/smoking cessation and longer-term sustained changes to lifestyle intentions post-surgery. Communicating the nature and purpose of the programme to patients was challenging and consequently the quality of the explanation received and understanding gained by patients was generally low. Insight into the successful implementation of health optimisation for the hip and knee pathway, but failure in roll-out to other surgical specialities, suggests placement of health optimisation interventions into the ‘usual waiting time’ for surgical referral may be of greatest acceptability to professionals and patients.ConclusionsPatients and professionals supported the continuation of health optimisation in this context and recognised likely health and wellbeing benefits for a majority of patients. However, the clinicians’ communication to patients about health optimisation needs to improve to prepare patients and optimise their engagement.
Highlights
Health optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery
Patients in this study indicated an expectation that their primary care clinicians raise weight management and smoking cessation recommendations with them at the point of surgical referral and did not find this problematic, with some stating they would welcome the offer of interventions to support them at this point
It was suggested that health optimisation (HO) during the ‘usual waiting time’ for surgical referral may be of greatest acceptability to professionals and patients
Summary
Health optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral. HO policies are applied to hip and knee elective surgery pathways Their purpose is to encourage eligible patients to lose weight, stop smoking and increase fitness before surgery. Existing literature highlights the ethical concerns around imposing thresholds for surgery and the rationing of healthcare based on factors commonly related to lifestyle choices, such as body mass index (BMI) [3, 4]. Over half of England’s clinical commissioning groups (CCGs) have such policies that ration access to joint replacement [6, 7]
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