Atlantis E, Kormas N, Samaras K, Fahey P, Sumithran P, Glastras S, Wittert G, Fusco K, Bishay R, Markovic T, Ding L, Williams K, Caterson I, Chikani V, Dugdale P, Dixon J
School of Nursing and Midwifery, Western Sydney University, Penrith, Australia.
Capital Markets Cooperative Research Centre, Sydney, Australia.
Clin Obes. 2018 Jun;8(3):203-210. doi: 10.1111/cob.12249. Epub 2018 Apr 23.
We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.
我们旨在描述澳大利亚公立医院为患有临床重度肥胖的成年人提供的专科肥胖服务的现状，并根据专家共识分析资源差距。我们进行了两项调查，使用开放式问卷收集有关当前和所需的专科肥胖服务及资源的信息。2017年，我们向澳大利亚各地专科肥胖服务的临床专家代表寻求机构层面的数据。新南威尔士州（n = 8）、昆士兰州（n = 1）、维多利亚州（n = 2）、南澳大利亚州（n = 3）和澳大利亚首都直辖区（n = 1）的16家现有服务机构中的15家提供了数据。各医院之间的服务构成差异很大，严格的准入标准（如体重指数40kg/m或更高且伴有特定并发症）、漫长的等待时间、地理位置（仅在主要城市）和自付费用限制了患者获得服务和有效治疗的机会。在这些服务机构中，47%拥有多学科团队（MDT），53%有运动生理学家/物理治疗师，53%有减肥外科医生，33%有药物治疗资源。主要差距包括MDT的人员配备（心理学家、运动生理学家/物理治疗师）以及获得公共资助的减肥药物治疗和减肥手术的机会。大家一致认为，在人员、物理基础设施、服务可及性、肥胖医学教育/培训以及针对性研究资金方面需要大幅改进。基于现有的、资源往往不足的少数专科肥胖服务机构仅位于少数几个主要城市这一情况，绝大多数患有临床重度肥胖的澳大利亚人无法获得所需的专科循证治疗。
