针对初级保健从业者以改善合并肥胖症患者识别与转诊的干预措施：一项实在论综述方案
Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol.
作者信息
Blane David N, Macdonald Sara, Morrison David, O'Donnell Catherine A
机构信息
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
Public Health, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
出版信息
Syst Rev. 2015 May 1;4:61. doi: 10.1186/s13643-015-0046-y.
BACKGROUND
Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process.
METHODS
Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components.
DISCUSSION
This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42014009391.
背景
肥胖是发达国家面临的最重大的公共卫生挑战之一。近期政策表明，在初级保健中可以采取更多措施来支持肥胖成年人。特别是，全科医生（GPs）和执业护士（PNs）可以改善对肥胖成年人的识别，并将其转介至适当的体重管理服务机构。此前针对该领域初级保健从业者的干预措施效果不一，这表明患者、从业者和系统之间存在更为复杂的相互作用。本综述的目的是：（i）确定针对初级保健从业者以改善肥胖成年人识别和转介情况的干预措施的潜在“项目理论”；（ii）探讨全科医生和执业护士如何以及为何识别和转介肥胖个体，尤其是在与体重相关的合并症背景下。本方案将解释采用现实主义综述方法的基本原理，并概述该过程中的关键步骤。
方法
现实主义综述是一种以理论为导向的知识综合方法，提供一种解释性分析，旨在辨别什么有效、对谁有效、在何种情况下有效、如何有效以及为何有效。在本综述中，对参与苏格兰成人体重管理服务规划和实施的关键利益相关者进行的范围界定访谈，有助于确定将在综述过程中进行检验的来自心理学、社会学和实施科学的正式理论。描述了全面的检索策略，包括迭代检索的范围。数据分析分三个阶段进行（描述背景 - 机制 - 结果配置、探索这些配置中的模式以及根据先前确定的正式理论制定和检验中程理论），最终形成考虑个体、人际和机构/系统层面因素的解释性项目理论。
讨论
据我们所知，这是第一项针对旨在改善肥胖成年人体重管理的初级保健从业者干预措施的现实主义综述。在早期阶段与利益相关者的参与是现实主义综述的一个独特特征。这塑造了综述的范围、候选理论的识别以及传播策略。本综述的结果将为政策和未来干预措施提供信息。
系统综述注册
PROSPERO CRD42014009391
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