Exploring the role of the general practitioner in obesity management in Australian primary care

Abstract

As obesity prevalence continues to rise, approximately one third of patients seen by Australian general practitioners (GPs) are living with obesity. General practice is the cornerstone of primary care in Australia with 85% of the population seeing a GP at least annually. The current role of the GP in obesity management focuses on care co-ordination with guidelines encouraging the referral of patients to allied health services, including dietitians and exercise physiologists. But multidisciplinary team care is not always available due to factors such as location and cost, or patients may have a preference for working more closely with their GP. Currently there are no weight management programs where care is delivered by a GP. This doctoral work explores the current role of the GP in obesity management in Australia, outlines an intervention development study for a GPdelivered weight management program, and presents the findings of a feasibility trial of the program. Following the UK Medical Research Council’s Guidelines for the Development of a Complex Intervention, a GP-delivered weight management program was developed. The draft program was based on Australian evidence-based guidelines for obesity management and used a qualitative approach to engage stakeholders to refine the program materials. Following this intervention development, a six-month feasibility trial was undertaken in five general practices involving 11 GPs and 23 patients. Guided by Normalisation Process Theory, both quantitative and qualitative data were collected. Both GPs and patients reported high rates of acceptability and feasibility, and there was a low dropout rate with only three patients withdrawing. Based on the theoretical framework of Bordin, patients and GPs with a strong therapeutic alliance had better program retention and there was a trend to improvement in some health outcomes. Social cognitive theory suggests that “performance mastery” is the most effective way to develop self-efficacy. This was demonstrated in the feasibility trial with both qualitative and quantitative data showing the GPs improved self-efficacy for obesity management. Based on the findings in the feasibility trial, a modified approach to obesity management in primary care is suggested with a greater emphasis on therapeutic relationship, person-centredness, and the explicit recognition that care occurs over time and not within one consultation. A GP-delivered weight management program in Australia was demonstrated to be feasible and acceptable to both patients and their GPs. Future research will focus on a pseudo-cluster randomised controlled trial for effectiveness, alongside further development of a measure for therapeutic alliance in general practice for research, teaching, and clinical purposes.