Abstract
BackgroundObesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour.Methods/designThe 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program.DiscussionThe 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care.Trial registrationNCT01967797.
Highlights
Obesity is a pressing public health concern, which frequently presents in primary care
Chronic disease nurses and nurse practitioners working in this multi-disciplinary setting present a good model to target and assess improvement in obesity management. The goal of this project is to implement and evaluate the 5As Team (5AsT) team intervention aimed at changing provider behaviour with regard to obesity management
Phase 2 is the ‘Passive Phase,’ a six-month period where we provide no direct support to the 5As Teams but continue to collect data to determine if behavior change has been internalized
Summary
Obesity is a pressing public health concern, which frequently presents in primary care. Obesity is ‘not effectively managed within our current primary health system’ [4,5,6] To address this problem, a tool for obesity counseling and management in primary care settings, known as the 5As of Obesity ManagementTM has been developed [7]. A tool for obesity counseling and management in primary care settings, known as the 5As of Obesity ManagementTM has been developed [7] This tool incorporates the conceptual structure of the Best Practices in Weight Management document, the Canadian Obesity Clinical Practice Guidelines [8], and the 5As methodological framework (Ask, Assess, Advise, Agree, Assist) [9]. The 5As have not been evaluated in a system-wide implementation study
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