What works and why in the identification and referral of adults with comorbid obesity in primary care: a realist review

Blane, D. , Macdonald, S. and O'Donnell, C. A. (2019) What works and why in the identification and referral of adults with comorbid obesity in primary care: a realist review. Obesity Reviews, (doi: 10.1111/obr.12979) (PMID:31867842) (Early Online Publication)

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Abstract

Primary care practitioners (PCPs) are well placed to identify individuals with obesity and weight‐related comorbidities and to refer them to weight management services (WMS), but this does not often happen in practice. In this realist review, we searched six databases for intervention studies targeted at PCPs to improve the identification and referral of adults with comorbid obesity. Realist analysis was used to identify context‐mechanism‐outcome (CMO) configurations across 30 included papers (reporting on 27 studies). Most studies used multiple intervention strategies, categorised into: (a) training, (b) tools to improve identification, (c) tools to improve ease of referral, (d) audit/feedback, (e) working in networks/quality circles, and (f) other. The realist synthesis identified 12 mechanisms through which interventions work to improve identification and referral, including increasing knowledge about obesity and awareness of and confidence in WMS among practitioners, improved communication and trust between practitioners and WMS, and higher priority given to weight management among primary care teams. The theory of “candidacy” (a person's eligibility for medical attention and intervention) provided a robust explanatory framework but required refinement: (a) to take account of the different services (primary care and weight management) that patients must navigate to access support; and (b) to acknowledge the importance of wider contextual factors.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:O'Donnell, Professor Kate and Blane, Dr David and Macdonald, Dr Sara
Authors: Blane, D., Macdonald, S., and O'Donnell, C. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:Obesity Reviews
Publisher:Wiley
ISSN:1467-7881
ISSN (Online):1467-789X
Published Online:22 December 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Obesity Reviews 2019
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
168801Understanding the role of primary care in the management of co-morbid obesity: a mixed methods programme.Catherine O'DonnellChief Scientist Office (CSO)CAF/13/13HW - General Practice and Primary Care