SIIReN - System Integration & Innovation Research Network

Primary Health Care System

Click here to open .pdf document
“Improved Weight Management in Primary Care"
Presenters:  P. Brauer, D. Royall, J.J.M. Dwyer, A.M. Edwards, R. Goy, T. Hussey, N. Kates, O. O'Young,
H. Smith, and R. Kirkconnell, University of Guelph
March 17, 2011


Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON; Nutrition Research Consulting, Fergus, ON; Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON; Department of Computing and Communications Services, University of Guelph, Guelph, ON; Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON; Hamilton Family Health Team, Hamilton, ON; Hamilton Family Health Team, Hamilton, ON, Guelph Family Health Team, Guelph ON; Guelph Family Health Team, Guelph, ON.

This program of work aimed to develop a flexible planning framework for action on obesity management in primary care.  Three relevant planning models/frameworks were used to organize the work: the Chronic Care Model, the WHO planning framework for prevention of chronic disease, and the MRC (UK) guide to developing and evaluating complex interventions. The goal of the current funding was to identify and prioritize possible approaches that would be applicable to Canadian inter-professional primary care organizations. 

We first conducted a scoping review (2003-2009) for evidence of improved obesity management in primary care – looking for innovations in “organization of care” from studies based on representative patient samples. Secondly, we conducted 11 focus groups with providers and patients in the Hamilton Family Health Team on ideas for new services.   The final phase was to draft and review a planning framework with one inter-professional group of providers – 11 members of the Guelph Family Health Team.  To facilitate decision making, electronic meeting software was employed in a one-day face-to-face meeting, which included nominal group, free discussion and rating and ranking exercises.  

Of 176 intervention studies, 48% focused on type 2 diabetes and 10 of 70 studies were conducted in groups likely to be representative and had promising results with hemoglobin A1c reductions of ≥1.0%.  Similarly 5 of 71 studies were promising with ≥ 3% weight loss.  Most prominent promising strategies in these studies were: 1. Enhanced interventions to help patients develop personal skills; 2. redesigning the delivery system (including changes in the organization of care); and 3. offering providers training and/or decision support tools.  Key themes from the focus groups for patient care included raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support.  Key priorities were identified using the electronic meeting approach. The method was highly rated by participants. A draft planning framework that blends health promotion with traditional clinical care processes has been developed and priority areas for further development identified.

Back to Research Rounds page