Blane David N, Macdonald Sara, Morrison David, O'Donnell Catherine A
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.
BMC Health Serv Res. 2017 Nov 21;17(1):764. doi: 10.1186/s12913-017-2729-7.
Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management.
Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach.
A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance).
Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow.
初级保健在肥胖症的预防和管理中发挥着关键作用，但初级保健从业者在参与体重管理方面仍存在障碍。本研究的目的是探讨成人体重管理服务中的关键利益相关者对初级保健在成人体重管理中的作用的看法。
定性研究，对来自苏格兰七个健康委员会参与英国国家医疗服务体系（NHS）体重管理的九名高级营养师进行半结构化访谈。使用归纳主题分析法对访谈记录进行分析。
在三个关键主题中出现了一系列矛盾：体重管理服务问题、初级保健的作用以及与初级保健的沟通。对于体重管理服务而言，这些矛盾围绕着资金、肥胖症管理模式以及如何配置服务获取途径。对于初级保健来说，矛盾在于初级保健应该做什么、谁来做以及这项活动应如何融入更广泛的体重管理政策。关于体重管理服务与初级保健之间的沟通，存在与所采取的方式（因地制宜与集中化）、传达的信息（体重减轻与健康）以及从业者的反应（参与与抵触）相关的矛盾。
初级保健在支持成人体重管理方面可以做得更多，但这需要与体重管理服务更好地合作与沟通，以克服本研究中突出的矛盾。反过来，这需要更稳定、持续的资金。英国戒烟的例子，即有一个资源充足的NHS戒烟服务网络，可通过不同方式获取，可能是一个可借鉴的模式。
