Professorship of Public Health and Prevention, School of Medicine and Health, Technical University of Munich, Munich, Germany,
Department Innovation in Health Care, German Foundation for the Chronically Ill, Berlin, Germany.
Obes Facts. 2024;17(3):311-324. doi: 10.1159/000538264. Epub 2024 Mar 27.
Almost 25% of German adults have obesity and numbers are rising, making it an important health issue. Bariatric-metabolic surgery reduces body weight and complications for persons with obesity, but therapeutic success requires long-term postoperative care. Since no German standards for follow-up by family physicians exist, follow-up is provided by surgical obesity centers, but they are reaching their limits. The ACHT study, funded by the German Innovation Fund, is designed to establish and evaluate the follow-up program, with local physicians following patients supported remotely by obesity centers.
ACHT is a multicenter, prospective, non-randomized control group study. The 18-month ACHT follow-up program is a digitally supported, structured, cross-sectoral, and close-to-home program to improve success after bariatric-metabolic surgery. Four groups are compared: intervention group 1 starts the program immediately (3 weeks) after Roux-en-Y gastric bypass or sleeve gastrectomy (months 1-18 postoperatively), intervention group 2 begins the program 18 months after surgery (months 19-36 postoperatively). Intervention groups are compared to respective control groups that had surgery 18 and 36 months previously. In total, 250 patients, enrolled in the intervention groups, are compared with 360 patients in the control groups, who only receive standard care.
The primary endpoint to compare intervention and control groups is the adapted King's score, a composite tool evaluating physical, psychological, socioeconomic, and functional health status. Secondary endpoints include changes in care structures and care processes for the intervention groups. Multivariate regression analyses adjusting for confounders (including the type of surgery) are used to compare intervention and control groups and evaluate determinants in longitudinal analyses. The effect of the intervention on healthcare costs will be evaluated based on health insurance billing data of patients who had bariatric-metabolic surgery in the 3 years prior to the start of the study and of patients who undergo bariatric-metabolic surgery during the study period.
ACHT will be the one of the first evaluated structured, close-to-home follow-up programs for bariatric surgery in Germany. It will evaluate the effectiveness of the implemented program regarding improvements in health status, mental health, quality of life, and the feasibility of such a program outside of specialized obesity centers.
近 25%的德国成年人患有肥胖症，且人数还在不断增加，这是一个重要的健康问题。减重代谢手术可以减轻肥胖患者的体重和并发症，但治疗成功需要长期的术后护理。由于德国没有家庭医生随访的标准，因此由肥胖症治疗中心提供随访服务，但这些中心已经达到了极限。ACHT 研究由德国创新基金资助，旨在建立和评估随访项目，由当地医生远程为肥胖症中心支持的患者提供服务。
ACHT 是一项多中心、前瞻性、非随机对照研究。为期 18 个月的 ACHT 随访项目是一个数字化支持的、结构化的、跨部门的、贴近家庭的项目，旨在提高减重代谢手术后的成功率。该研究比较了四个组：干预组 1 在 Roux-en-Y 胃旁路术或袖状胃切除术（术后 1-18 个月）后立即开始该项目（术后 1-18 个月），干预组 2 在手术后 18 个月开始该项目（术后 19-36 个月）。干预组与之前手术 18 个月和 36 个月的对照组进行比较。共有 250 名干预组患者和 360 名对照组患者（仅接受标准护理）入组进行比较。
比较干预组和对照组的主要终点是改良的 King 评分，这是一种综合工具，用于评估身体、心理、社会经济和功能健康状况。次要终点包括干预组的护理结构和护理过程的变化。使用调整混杂因素（包括手术类型）的多变量回归分析比较干预组和对照组，并在纵向分析中评估决定因素。将根据研究开始前 3 年内接受减重代谢手术的患者和研究期间接受减重代谢手术的患者的医疗保险计费数据，评估该干预对医疗保健成本的影响。
ACHT 将成为德国首个经过评估的结构化、贴近家庭的减重手术随访项目之一。它将评估所实施的项目在改善健康状况、心理健康、生活质量方面的有效性，以及在专门的肥胖症治疗中心之外实施此类项目的可行性。
