Brook Emma, Cohen Lauren, Hakendorf Paul, Wittert Gary, Thompson Campbell
University of Adelaide, Adelaide, South Australia, Australia.
BMC Health Serv Res. 2014 Feb 20;14:78. doi: 10.1186/1472-6963-14-78.
There is conflicting evidence regarding characteristics of patients most likely to have poor outcomes after referral to a multidisciplinary weight loss clinic. The aim of this study was to identify patient characteristics associated with poor attendance and poor weight outcomes at a weight management clinic based in an Australian tertiary hospital.
Patient characteristics including age, sex, referral source, postcode of residence, weight, body mass index (BMI) and the presence of specific comorbidities were recorded. Outcome measures included questionnaire return following referral (a requirement prior to a first appointment being scheduled), percentage of appointments attended and rate of weight change (kg/month). Continuous variables were expressed as mean ± standard deviation and compared using a t-test. Categorical data were presented as proportions and a chi-squared test was used to test significance. Statistical significance was set as p < 0.05.
Of 502 patients referred to the Comprehensive Metabolic Care Centre (CMCC), 231 (46%) did not return their questionnaire. Patients referred by their GP, compared to those with only internal hospital referrals, were more likely to return their questionnaire (86.0% cf. 77.9%; p = 0.02) as were those who had their BMI recorded in their referral letter (58% cf 45% p = 0.011). 28.1% of patients attended half or less of their scheduled appointments at the CMCC but none of the parameters analysed was associated with attendance. Weight loss was associated with residence in a rural location (p = 0.016) and hypercholesterolaemia (p = 0.03) and weight gain was associated with obstructive sleep apnoea (p = 0.04).
A large proportion of the patients referred to a weight management clinic never had an appointment scheduled. Clinicians should not anticipate greater compliance in one patient demographic than another; all groups need focus, particularly at the referral stage, and likely poor compliance must be anticipated and better managed.
关于转诊至多学科减肥诊所后最有可能出现不良结局的患者特征，证据存在冲突。本研究的目的是确定澳大利亚一家三级医院的体重管理诊所中与就诊率低和体重结局差相关的患者特征。
记录患者特征，包括年龄、性别、转诊来源、居住邮编、体重、体重指数（BMI）以及特定合并症的存在情况。结局指标包括转诊后的问卷回复率（首次预约安排前的一项要求）、就诊预约的出席率以及体重变化率（千克/月）。连续变量以均值±标准差表示，并使用t检验进行比较。分类数据以比例呈现，并使用卡方检验来检验显著性。统计学显著性设定为p < 0.05。
在转诊至综合代谢护理中心（CMCC）的502名患者中，231名（46%）未回复问卷。与仅由医院内部转诊的患者相比，由全科医生转诊的患者更有可能回复问卷（86.0% 对 77.9%；p = 0.02），在转诊信中记录了BMI的患者也是如此（58% 对 45%，p = 0.011）。28.1%的患者在CMCC出席的预约不到一半，但分析的参数均与就诊率无关。体重减轻与居住在农村地区（p = 0.016）和高胆固醇血症（p = 0.03）有关，体重增加与阻塞性睡眠呼吸暂停（p = 0.04）有关。
转诊至体重管理诊所的患者中有很大一部分从未安排过预约。临床医生不应期望某一患者群体的依从性高于另一群体；所有群体都需要关注，尤其是在转诊阶段，必须预见到可能较差的依从性并进行更好的管理。
