To develop an evidence-based adult obesity care pathway collaboratively across Bassetlaw Primary Care General Practices and to ensure successful implementation of the pathway within primary care. Consequently, to evaluate the effectiveness of implementing an adult obesity care pathway in primary care, using qualitative and quantitative methods.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
To develop an evidence-based adult obesity care pathway collaboratively across Bassetlaw Primary Practices and to ensure successful implementation of the pathway within primary care. Consequently, to evaluate the effectiveness of implementing an adult obesity care pathway in primary care, using qualitative and quantitative methods.
1. To develop an evidence-based adult obesity care pathway based on the NICE obesity guidance, but incorporating local referral criteria and input.
2. To successfully implement the adult obesity care pathway across all general practices within the sector.
3. To evaluate the effectiveness of the adult obesity care pathway, in the short, and to assess the longer term benefits, sustainability and dissemination.
4. To look at ways of improving the service to further benefit patients.
5. To identify key success factors for implementation in other regions.
Reasons for implementing your project
Obesity is a problem that needs to be tackled as a major priority. Local Area Agreements & the Bassetlaw Strategic Partnership for Health (2009-2011) cite the need to try to tackle this emerging problem. Part of the Bassetlaw Local Strategic Partnership (BLSP) planned objectives and actions to reduce obesity is to supply the development of initiatives to help people to lose weight and /or maintain weight. As a result an accredited weight management programme has been developed, so that Clinical staff can participate in this programme with a view to developing evidence based weight management programmes. Tangible measures and outcomes form part of the BLSP.
The PCT launched a Locally Enhanced Service (LES) at the end of 2008 to encourage Primary Care providers to develop accredited weight management group programmes of excellence to help to address the problem.
A number of key problem areas were identified: service provision varied across the PCTs and within general practice. Staff were often insufficiently trained, services were often under resourced and over-referred (e.g. dietetics), and in some cases not provided (e.g. weight management clinics). The management of patients was not systematic and structured (e.g. patients not provided with first line advice prior to drug treatment).
An adult obesity care pathway was subsequently developed to translate the NICE obesity guidance into a local protocol, which could be implemented within primary care.
A standardised brand and patient pack along with a course leader package were developed. This included an electronic Systmone template for GP computer systems. Training events were held to launch the pathway and provide training for practice nurses and healthcare professionals in first line advice during patient consultations. A patient information leaflet was developed, along with operations procedures And guidance for practices to refer to.
How did you implement the project
Chrysalis has been developed and delivered by Practice staff that have attended an accredited weight management training programme, providing an opportunity that truly integrates medical treatment, guidance on diet, and the opportunity to engage in leisure and fitness activities. The programmes can be accessed by patients of the practices of Retford, and patients at Misterton & Gringley in mornings & evenings making best use of staff and resources, as well as offering choice to patients. Patients are initially assessed to see if they are eligible under the terms of the service (LES), with baseline measurements. A series of motivational questions are used to assess whether the patient is ready to make lifestyle changes to lose weight. The patients would then embark upon a 12 x 1, hour session of education and lifestyle analysis and change. Many groups run at any one time, with a choice of times ranging from mornings to evenings, and at 3 different locations, with the potential & desire to expand to other surgeries.
Session content is pre-prepared presentation materials, handouts, and interactive exercises to engage patients with the process. It also ensures that different course leaders deliver consistent themes and messages, consistent with the BLSP.
Patients receive a personal plan in & record their progress, set goals for following sessions and targets. These vary from weight loss, to improving health, fitting into clothes, feeling better about themselves, looking good. Each patient gets a step counter to monitor walking and a food diary, so they can analyse and modify their diet. During sessions they think critically about what it is that has made them overweight and provided with tools and help lead a healthier lifestyle. Patients are not told what to do, but they are educated on the benefits of making small lifestyle changes one step at a time. In this way they can learn to control their weight and slowly reduce it in a managed and safe way.
Each session patients are weighed, and progress is discussed individually to identify problem areas. Progress of the patients in groups is shared but anonymised. Quarterly in depth analysis occurs of patient demographics, attendance and weight loss. Patient satisfaction is also monitored by survey. After 18 months we have completed over 700 patient interventions. Results have been excellent with 80% attending half or more sessions and 60% of those achieving target weight loss. After 12 months 63 % of patients reviewed have either maintained their weight loss or continued to lose. Patient feedback is excellent especially when compared to similar programmes that they have attended.
The programmes compare excellently to other similar group based interventions previously carried out, weight loss doubled, patient numbers succeeding to target increased by 50%.
We utilise patient feedback to review and improve programmes, and have recently launched an online calorie comparator to further aid supporting and educating patients.
Key learning points
1. Training of clinical delivery staff, GPs and front line staff were crucial for successful implementation, and patient engagement.
2. Branding has proved an important element for the service, getting away from the labels that are associated with Obesity. This helps to promote communication and helps patients realise what is available.
3. Motivation and a willingness to changes for patients is vital, some patients may not be ready to embark upon the changes required to be successful.
4. Making sessions interactive are key component, as well as making sure key messages are simple
5. Making activity options available is important, so local partnerships with Leisure Centres can be valuable
6. Online support and accessible information can support engagement.
7. Electronic component of the pathway increased implementation levels and act as a prompt for clinicians to refer. The pathway supported by electronic templates was a valuable addition.
8. Communication of results to ALL stakeholders has been key to continuing support for the project.
Is the example industry-sponsored in any way?