Brauer Paula, Royall Dawna, Dwyer John, Edwards A Michelle, Hussey Tracy, Kates Nick, Smith Heidi, Kirkconnell Ross
1Associate Professor,Department of Family Relations and Applied Nutrition,University of Guelph,Guelph,ON,Canada.
2Research Coordinator,Department of Family Relations and Applied Nutrition,University of Guelph,Guelph,ON,Canada.
Prim Health Care Res Dev. 2017 Mar;18(2):135-147. doi: 10.1017/S1463423616000372. Epub 2016 Oct 3.
Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services.
It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.
The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3-12, 13-18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education.
Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.
目的 我们报告一项形成性项目，旨在为肥胖预防与管理服务制定一个组织层面的规划框架。
在开发新服务时，通常首先要制定一个逻辑模型，概述预期成果和关键流程。这对单个基层医疗组织来说可能很繁琐，尤其是对于像肥胖这样的复杂病症。
初始草案由研究团队根据安大略省一个大型家庭健康团队（FHT）中提供者和患者焦点小组的结果制定。该草案由20个FHT通过主持的电子共识流程进行审查并对活动进行优先排序。然后一个全国性小组对草案进行了审查。结果 提供者确定了五个主要目标群体：孕期至2岁、3至12岁、13至18岁、有健康风险的18岁以上人群以及有复杂护理需求的18岁以上人群。确定了期望的成果，并在以下类别中对活动进行了优先排序：提高认识（例如，提供有关体重与健康的信息和资源）、识别与初始管理（例如，健康护理）、后续管理（例如，团体项目）、扩展服务（例如，团队服务的可用性）以及实践举措（例如，跨专业教育）。总体而言，通过提供有关体重与健康联系以及社区服务的信息来提高认识得到了大力支持。在儿科护理中对生长评估也有大力支持。在成年人中，对健康护理/健康检查就诊以及针对确定干预对象的偶发性护理、团体项目和额外的提供者教育有大力支持。
不同团队的联合开发被证明有助于就成果达成共识并确保各实践之间的相关性。虽然优先事项会因当地情况而异，但护理流程的基本描述得到了审查者的认可。接下来的关键步骤是试用该框架，并进行进一步的实施研究，以找到在整个生命周期中预防和管理肥胖的最佳有效方法。
