Lau David C W, Patton Ian, Lavji Reena, Belloum Adel, Ng Ginnie, Modi Renuca
Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Obesity Canada, Edmonton, Alberta, Canada.
Clin Obes. 2025 Feb;15(1):e12701. doi: 10.1111/cob.12701. Epub 2024 Sep 3.
This mixed-methods study aimed to explore factors contributing to therapeutic inertia among people living with obesity in Canada from the perspective of general/family practitioners (GP/FPs). One-on-one interviews and online surveys guided by the Theoretical Domains Framework were conducted. A total of 20 general/family practitioners were interviewed and 200 general/family practitioners were surveyed. Key findings from interviews were used to guide the development of the survey. Spearman's correlation analysis evaluated the association between general/family practitioners theme domain scores and their familiarity with the 2020 Canadian Adult Obesity Clinical Practice Guidelines. The 200 general/family practitioners surveyed provided representation across Canada, with diversity in age, background, and gender. The most prominent domains related to therapeutic inertia that were positively influenced by familiarity with Clinical Practice Guidelines were Beliefs about Capabilities (r = .27; p < .01), Skills (r = .23; p < .01), Behavioural Regulation (r = .24; p < .01) and Emotions (r = .23; p < .01). Irrespective of their familiarity with Clinical Practice Guidelines, most general/family practitioners reported that environmental and contextual barriers impact obesity management. Particularly, while financial barriers were reported by participants regardless of Clinical Practice Guidelines familiarity, general/family practitioners familiar with Clinical Practice Guidelines more often reported having time to discuss obesity management with patients. This study identified perceptions, resource and training considerations that contribute to healthcare decision-making and therapeutic inertia in obesity management among general/family practitioners and highlighted key areas to target with interventions in primary care to facilitate obesity management, which should be multi-faceted, with a focus on incorporating obesity education into healthcare providers training programs and improving systemic and financial support.
这项混合方法研究旨在从普通/家庭医生（GP/FPs）的角度探讨加拿大肥胖症患者治疗惰性的影响因素。采用理论领域框架指导下的一对一访谈和在线调查。共访谈了20名普通/家庭医生，并对200名普通/家庭医生进行了调查。访谈的主要结果用于指导调查问卷的编制。Spearman相关性分析评估了普通/家庭医生主题领域得分与他们对《2020年加拿大成人肥胖临床实践指南》的熟悉程度之间的关联。参与调查的200名普通/家庭医生代表了加拿大各地，在年龄、背景和性别方面具有多样性。与治疗惰性最相关且受对临床实践指南的熟悉程度积极影响的领域是能力信念（r = 0.27；p < 0.01）、技能（r = 0.23；p < 0.01）、行为调节（r = 0.24；p < 0.01）和情绪（r = 0.23；p < 0.01）。无论对临床实践指南的熟悉程度如何，大多数普通/家庭医生报告称环境和背景障碍会影响肥胖管理。特别是，无论是否熟悉临床实践指南，参与者都报告了经济障碍，而熟悉临床实践指南的普通/家庭医生更常报告有时间与患者讨论肥胖管理。本研究确定了影响普通/家庭医生肥胖管理中医疗决策和治疗惰性的观念、资源和培训因素，并强调了初级保健干预的关键目标领域，以促进肥胖管理，干预应是多方面的，重点是将肥胖教育纳入医疗服务提供者培训计划，并改善系统和财政支持。
