The Change Program: A pilot implementation trial of a general practitioner-delivered weight management program in primary care

This pilot study aims to evaluate the feasibility of a GP-delivered weight management program for overweight and obese adults in primary care. The project team will receive both qualitative and quantitative feedback from participating GPs and their patients regarding the usefulness, practicality and implementation of the program that has been developed.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Metabolic syndrome and weight management programs in primary care: a comparison of three international healthcare systems

Lifestyle behaviours are contributing to the increasing incidence of chronic disease across all developed countries. Australia, Canada and the UK have had different approaches to the role of primary care in the prevention and management of lifestyle-related diseases. Both obesity and metabolic syndrome have been targeted by programs to reduce individual risk for chronic disease such as type 2 diabetes. Three interventions are described- for either obesity or metabolic syndrome - that have varying levels of involvement of GPs and other primary care professionals. The structure of a healthcare system for example, financing and physical locations of primary care clinicians, shapes the development of primary care interventions. The type of clinicians involved in interventions, whether they work alone or in teams, is influenced by the primary care setting and resource availability. Australian clinicians and policymakers should take into account the healthcare system where interventions arc developed when translating interventions to the Australian context

Role of the family doctor in the management of adults with obesity: a scoping review

Objectives Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. Setting Primary care. Adult patients. Included papers Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 nonduplicate papers were identified and 225 articles included after full-text review. Primary and secondary outcome measures Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. Results 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. Conclusions There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development

Increasing general practitioners' confidence and self-efficacy in managing obesity: a mixed methods study

Objectives: Internationally, general practitioners (GPs) are being encouraged to take an active role in the care of their patients with obesity, but as yet there are few tools for them to implement within their clinics. This study assessed the self-efficacy and confidence of GPs before and after implementing a weight management programme in their practice. Design: Nested mixed methods study within a 6- month feasibility trial. Setting: 4 urban general practices and 1 rural general practice in Australia. Participants: All vocationally registered GPs in the local region were eligible and invited to participate; 12 GPs were recruited and 11 completed the study. Interventions: The Change Programme is a structured GP-delivered weight management programme that uses the therapeutic relationship between the patient and their GP to provide holistic and person-centred care. It is an evidence-based programme founded on Australian guidelines for the management of obesity in primary care. Primary outcome measures: Self-efficacy and confidence of the GPs when managing obesity was measured using a quantitative survey consisting of Likert scales in conjunction with pro forma interviews. Results: In line with social cognitive theory, GPs who experienced performance mastery during the pilot intervention had an increase in their confidence and selfefficacy. In particular, confidence in assisting and arranging care for patientswas improved as demonstrated in the survey and supported by the qualitative data.Most importantly from the qualitative data, GPs described changing their usual practice and felt more confident to discuss obesity with all of their patients. Conclusions: A structured management tool for obesity care in general practice can improve GP confidence and self-efficacy in managing obesity. Enhancing GP 'professional self-efficacy' is the first step to improving obesity management within general practice.This work was supported by the Australian Primary Health Care Research Institute via a 2014 Foundation Grant

Integrating care: Learning from first generation integrated primary health care centres

Recent Australian health care policies have focused on strategies to increase efficiency, reduce inequalities and improve health outcomes by building a stronger primary health care system.1 At the time this research was commissioned, the establishment of GP Super Clinics was a significant strategic element of primary health care system reform, although this has now transitioned under subsequent governments to a focus on Health Care Homes.2 The research described in this report was funded by the Australian Primary Health Care Research Institute (APHCRI) in 2013 as part of a research program investigating the features of GP Super Clinics that contribute to achieving the objectives of integration. Specifically, this program of research explored co-location as a strategy for promoting service integration within multidisciplinary primary healthcare clinics, to identify developmental and operational characteristics that promote successful integration.3 Key elements of all 'extended general practice models' 4 are a focus on improving integration to drive quality of care, chronic disease management and prevention; coordination between and across services; increased access, and possibly the promotion of workforce development. While such services have been differentiated from broader primary health care centre models' such as Aboriginal Community Controlled Health Services (ACCHSs), both GP Super Clinics and ACCHSs share an integrated, co-located model of service. While we acknowledge there are significant differences (including the Non-Government Organisation (NGO) focus, not-for-profit status and specific Aboriginal employment contexts) for ACCHSs compared to Super Clinics, many of the challenges of establishing and sustaining integrated primary health care are common across both service types.4 Any initiative seeking to understand characteristics of integrated primary healthcare centres (IPHCs) is likely to derive useful lessons from ACCHSs, which predate the GP Super Clinic model by nearly 40 years. The ACCHS sector has established strategies to ensure collaboration across disciplines, to be properly responsive to changing community needs, and to build effective links within and across services. In many cases, these models have benefited from the fine tuning and maturity that accompanies several decades of implementation. Many of the quality innovations in primary health care which are now moving into broader general practice settings, from quality indicators to the Health Care Home, were pioneered in the ACCHS sector.5 Newer models of co-located integrated primary health care are also offered by some community-based refugee health services which provide co-located, integrated psychology, medical, nursing and social care services. These broad-based primary care services for specific populations offer more social service support than the IPHCs which focus on primary medical care for general populations, but both models share the primary care mandate to provide patient-centred, whole person care. This research report describes two case studies exploring characteristics of two different colocated, integrated services: a mature integrated ACCHS, Winnunga Nimmityjah Aboriginal Health Service (Winnunga Nimmityjah AHS); and a rapidly expanding IPHC, Companion House, supporting refugees and asylum seekers. These services are both award-winning organisations that provide primary general practice (GP) medical care as well as more generalised health services to members of their local community. They function as exemplar case models, each highlighting different challenges that IPHCs may have. Both organisations are important community hubs and have had to frequently adapt to shifting needs and priorities of both their communities and of government policies that impact them directly.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Increasing general practitioners' confidence and self-efficacy in managing obesity: a mixed methods study

Contains fulltext : 175760.pdf (publisher's version ) (Open Access)OBJECTIVES: Internationally, general practitioners (GPs) are being encouraged to take an active role in the care of their patients with obesity, but as yet there are few tools for them to implement within their clinics. This study assessed the self-efficacy and confidence of GPs before and after implementing a weight management programme in their practice. DESIGN: Nested mixed methods study within a 6-month feasibility trial. SETTING: 4 urban general practices and 1 rural general practice in Australia. PARTICIPANTS: All vocationally registered GPs in the local region were eligible and invited to participate; 12 GPs were recruited and 11 completed the study. INTERVENTIONS: The Change Programme is a structured GP-delivered weight management programme that uses the therapeutic relationship between the patient and their GP to provide holistic and person-centred care. It is an evidence-based programme founded on Australian guidelines for the management of obesity in primary care. PRIMARY OUTCOME MEASURES: Self-efficacy and confidence of the GPs when managing obesity was measured using a quantitative survey consisting of Likert scales in conjunction with pro forma interviews. RESULTS: In line with social cognitive theory, GPs who experienced performance mastery during the pilot intervention had an increase in their confidence and self-efficacy. In particular, confidence in assisting and arranging care for patients was improved as demonstrated in the survey and supported by the qualitative data. Most importantly from the qualitative data, GPs described changing their usual practice and felt more confident to discuss obesity with all of their patients. CONCLUSIONS: A structured management tool for obesity care in general practice can improve GP confidence and self-efficacy in managing obesity. Enhancing GP 'professional self-efficacy' is the first step to improving obesity management within general practice. TRIAL REGISTRATION NUMBER: ACTRN12614001192673; Results

Role of the family doctor in the management of adults with obesity: a scoping review

Contains fulltext : 191345.pdf (publisher's version ) (Open Access)OBJECTIVES: Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. SETTING: Primary care. Adult patients. INCLUDED PAPERS: Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. RESULTS: 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. CONCLUSIONS: There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development

How does studying rurally affect peer networks and resilience? A social network analysis of rural- and urban-based students

Objective To examine differences in peer networks between urban‐based students and rural‐stream students in an Australian medical school and to examine how characteristics of networks relate to resilience. Design Cross‐sectional survey asking students to signify social, academic and support relationships with students in the same year and to complete a survey on their resilience. Setting and participants All second‐, third‐ and fourth‐year students at the Australian National University Medical School. Main outcome measures Social network analysis comparing peer networks, t‐test comparing mean resilience of urban and rural students. Results A visual analysis of the peer networks of year 2, 3 and 4 medical students suggests greater integration of rural‐stream students within the year 2 and 4 urban cohorts. Resilience is similar between year 2 and 3 students in both urban and rural streams, but is significantly higher in year 4 rural‐stream students, compared to their urban‐based peers. Networks of rural‐stream students suggest key differences between their period spent rurally and on their return and integration within the larger student cohort. Furthermore, rural students, once reintegrated, had larger and stronger social networks than their urban counterparts. Conclusion The results of the study suggest that the rural experience can instruct support systems in urban settings. However, whether the rural placement creates a more resilient student or resilient students are selected for rural placement is unclear.This project was funded by a College of Higher Education Learning and Teaching grant from the ANU