Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.
BMC Fam Pract. 2021 Apr 2;22(1):61. doi: 10.1186/s12875-021-01404-0.
The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network.
In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models.
More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up.
To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.
The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).
初级医疗保健环境被认为是成功管理肥胖的重要起点。然而，研究表明初级保健中的体重咨询质量不足。本研究的目的是实施和评估一种 5A 在线教程，旨在改善初级医疗保健中的体重管理和医患互动。该在线教程是一种基于加拿大肥胖网络肥胖管理 5A 指南的针对全科医生的独立、低门槛的最小电子健康干预措施。
在一项集群随机对照试验中，50 家初级保健诊所纳入了 160 名年龄在 18 至 60 岁之间的肥胖患者（BMI≥30）。干预诊所的医生可以持续访问 5A 在线教程。对照组患者接受常规治疗。主要结局是患者对肥胖管理的医患互动的看法，使用慢性病患者评估前后（6/12 个月）进行评估。使用混合效应线性回归模型评估随时间的治疗效果（意向治疗）。
超过一半的医生（57%）希望提供更多的肥胖咨询培训。干预组的 76%的医生完成了 5A 在线教程。混合效应回归分析结果显示，在 6 个月和 12 个月的随访中，PACIC 5A 总分没有治疗效果。干预组的肥胖患者在 6 个月的随访中自我污名化和体重管理准备程度得分低于对照组，但在 12 个月的随访中，体重、生活质量、参与体重管理的准备程度、自我污名化和抑郁方面无显著组间差异。
据我们所知，本研究提供了德国初级保健环境中基于 5A 的干预的首个长期结果。结果表明，独立的、低门槛的最小电子健康干预措施不能长期改善初级保健中的体重管理。要改善初级保健中的体重管理，需要更全面的策略。然而，由于招募困难，最终样本比预期的要小。这可能导致了无效的结果。
该研究已在德国临床试验注册处（标识符：DRKS00009241，注册日期：2016 年 2 月 3 日）注册。
