Bloom Kate, Adler Jaime, Bridges Christy, Bernstein Julia, Rini Christine, Goldstein Adam O, Ripley-Moffitt Carol
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
J Prim Prev. 2018 Aug;39(4):387-399. doi: 10.1007/s10935-018-0516-9.
Obesity affects more than one-third of Americans and is a leading cause of preventable death. Integrating patient perspectives into obesity treatment can help primary care providers (PCPs) intervene more effectively. In this study, we describe patients' experiences with PCPs concerning the diagnosis and treatment of obesity and offer suggestions for patient-centered care in weight management. We conducted four focus groups with patients of a university medical system-associated family practice who had a BMI ≥ 30. Interview questions addressed general weight management perceptions and preferences for weight management support in a primary care setting. Patients completed a brief demographic survey at the conclusion of the group. Four authors independently coded focus group notes to identify themes and determine saturation using qualitative thematic analysis. We resolved discrepancies by team discussion. Thirty primary care patients participated, of whom 23 were female and whose average age was 50. Twenty-four had attempted to lose weight in the past 12 months and had discussed management with their providers. Analyses identified four themes regarding weight management in a primary care setting: motivation and weight management, the provider-patient relationship, desire for concrete weight loss plans, and limitations of the primary care setting. Motivation was named as a weight management obstacle. Participants felt that PCPs need to be partners in weight management efforts and also recognized limitations of PCP time and expertise. They endorsed an integrated behavioral approach that includes physical activity and nutrition support. Improving PCP delivery of evidence-based treatment for obesity will lead to increased patient attempts to lose weight. Incorporating patients' desires for concrete plans, ongoing support, and referral to integrated service (e.g., nutritionists, care managers, behavioral health providers) programs can increase patient engagement and success. The chronic disease care and Patient Centered Medical Home models offer guidance for ensuring sustainability of weight management services.
肥胖影响着超过三分之一的美国人，是可预防死亡的主要原因。将患者的观点纳入肥胖治疗可以帮助初级保健提供者（PCP）更有效地进行干预。在本研究中，我们描述了患者在肥胖诊断和治疗方面与初级保健提供者的经历，并为以患者为中心的体重管理护理提供建议。我们对一所大学医疗系统附属家庭诊所中BMI≥30的患者进行了四个焦点小组访谈。访谈问题涉及一般体重管理认知以及在初级保健环境中对体重管理支持的偏好。患者在小组结束时完成了一份简短的人口统计学调查。四位作者独立对焦点小组记录进行编码，以识别主题并通过定性主题分析确定饱和度。我们通过团队讨论解决了差异。30名初级保健患者参与其中，其中23名是女性，平均年龄为50岁。24人在过去12个月中尝试过减肥，并与他们的医疗服务提供者讨论过管理方法。分析确定了在初级保健环境中体重管理的四个主题：动机与体重管理、医患关系、对具体减肥计划的渴望以及初级保健环境的局限性。动机被认为是体重管理的障碍。参与者认为初级保健提供者需要成为体重管理工作中的合作伙伴，同时也认识到初级保健提供者时间和专业知识的局限性。他们认可一种包括体育活动和营养支持的综合行为方法。改善初级保健提供者对肥胖的循证治疗将导致患者增加减肥尝试。纳入患者对具体计划、持续支持以及转介到综合服务（如营养师、护理经理、行为健康提供者）项目的需求，可以提高患者的参与度和成功率。慢性病护理和以患者为中心的医疗之家模式为确保体重管理服务的可持续性提供了指导。
