Zevin Boris, Dalgarno Nancy, Martin Mary, Grady Colleen, Matusinec Jacob, Houlden Robyn, Birtwhistle Richard, Smith Karen, Morkem Rachael, Barber David
Department of Surgery (Zevin), Queen's University; Office of Professional Development and Educational Scholarship (Dalgarno), Faculty of Health Sciences, Queen's University; Department of Biomedical and Molecular Science (Dalgarno), Queen's University; Centre for Studies in Primary Care (Martin, Grady, Matusinec, Birtwhistle, Morkem, Barber), Department of Family Medicine, Queen's University; Department of Medicine (Houlden), Queen's University; Department of Physical Medicine and Rehabilitation (Smith), Queen's University, Kingston, Ont.
CMAJ Open. 2019 Dec 13;7(4):E738-E744. doi: 10.9778/cmajo.20190072. Print 2019 Oct-Dec.
Over 1 million Canadians have class II or III obesity; however, access to weight-loss interventions for these patients remains limited. The purpose of our study was to identify the barriers to accessing medical and surgical weight-loss interventions from the perspectives of 3 groups: family physicians, patients who were referred for weight-loss intervention and patients who were not referred for weight-loss intervention.
Between November 2017 and May 2018, we conducted a qualitative exploratory research study using focus groups with family physicians and interviews with patients with class II or III obesity from 1 region in southern Ontario. We conducted a thematic analysis to identify emergent themes and used the barriers to change theory to classify the similarities and differences between the perspectives of family physicians, referred patients and nonreferred patients in first- and second-order barriers.
Seventeen family physicians participated in 7 focus groups (1-4 participants/group), and we interviewed 8 referred patients and 7 nonreferred patients. We identified lack of resource supports, logistics and lack of knowledge about weight-loss interventions as first-order barriers to change, and lack of knowledge about root causes of obesity, lack of patient readiness for change and family physicians' perceptions about surgical weight loss as second-order barriers to change. Family physicians and patients had similar perceptions regarding lack of resource supports in the community, logistical issues, family physicians' lack of knowledge regarding weight-loss interventions, patients' lack of motivation and family physicians' perceptions of bariatric surgery as being high risk. They differed regarding the root cause of obesity, with family physicians attributing obesity to multiple extrinsic and intrinsic causes, whereas patients believed obesity was largely due to intrinsic causes alone.
It is important to address first- and second-order barriers to accessing weight-loss interventions through continuing professional development activities for family physicians to help ensure effective and timely treatment for patients with class II or III obesity and related comorbidities.
超过100万加拿大人患有II级或III级肥胖症；然而，这些患者获得减肥干预措施的机会仍然有限。我们研究的目的是从三组人群的角度确定获得医学和手术减肥干预措施的障碍：家庭医生、被转诊接受减肥干预的患者以及未被转诊接受减肥干预的患者。
在2017年11月至2018年5月期间，我们进行了一项定性探索性研究，对家庭医生进行焦点小组访谈，并对安大略省南部一个地区的II级或III级肥胖患者进行访谈。我们进行了主题分析以确定新出现的主题，并使用变革障碍理论对家庭医生、被转诊患者和未被转诊患者在一阶和二阶障碍方面的观点异同进行分类。
17名家庭医生参加了7个焦点小组（每组1 - 4名参与者），我们访谈了8名被转诊患者和7名未被转诊患者。我们确定缺乏资源支持、后勤问题以及对减肥干预措施的知识缺乏为一阶变革障碍，而对肥胖根本原因的知识缺乏、患者对改变的准备不足以及家庭医生对手术减肥的看法为二阶变革障碍。家庭医生和患者对社区缺乏资源支持、后勤问题、家庭医生对减肥干预措施的知识缺乏、患者缺乏动力以及家庭医生认为减肥手术风险高的看法相似。他们在肥胖的根本原因上存在差异，家庭医生将肥胖归因于多种外在和内在原因，而患者认为肥胖主要仅由内在原因导致。
通过为家庭医生开展持续专业发展活动来解决获得减肥干预措施的一阶和二阶障碍非常重要，以帮助确保为患有II级或III级肥胖症及相关合并症的患者提供有效和及时的治疗。
