Planning Framework for Weight Management in Primary Care

Abstract

This initiative aimed to develop a flexible population-based planning framework for interprofessional primary care organizations to manage obesity. A scoping literature review (2003-2012) was completed to identify evidence of improved obesity management in primary care. In the second phase, focus groups were conducted with providers and patients; transcripts were thematically analyzed for ideas on new services. The final phase was review of the planning framework by 19 Family Health Teams in Ontario using a moderated consensus process and electronic meeting software. A national panel reviewed the draft, with help from the Canadian Obesity Network. The scoping review revealed that about 80% of intervention studies were directed to diabetes and/or cardiovascular diseases in adults. The most promising strategies included intensive skills training with patients, case management, provider education and additional provider tools (e.g. treatment algorithms and access to specialist expertise). For program planning purposes, providers identified 5 target groups: pregnancy to 2 yrs, 3-12 yrs, 13-18 yrs, 18+ yrs at risk or with health conditions, and 18+ with complex care needs. Desired outcomes for each target group were identified and activities were prioritized under categories: raising awareness, identification and initial management, follow-up management, expanded services, and practice initiatives. Evidence supports only some approaches that were important to providers. This novel planning tool clarifies key goals at different life stages and by health condition, and indicates where evidence and provider perspectives both converge and differ in developing program strategies to manage obesity. To date, the framework has facilitated priority setting in teams planning new services and implementation studies.