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A shared care approach in obesity management: the general practitioner and a hospital based service
R M Richman1, P Webster, A R Salgo
1Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Objective:
To describe the process of establishing a Shared Care obesity management programme between general practitioners and a hospital based specialist obesity service and to compare outcomes of the Shared Care programme (SC) to an established hospital based programme (MOS).
Design:
A comparative study of two obesity management programmes. Patients were matched on gender, age and BMI (kg/m2).
Subjects:
29 female and eight male (age: 47.0 +/- 2 years, BMI 35.9 +/- 0.8 kg/m2) patients enrolled in the Shared Care programme (SC) were matched to 81 female and 20 male (age: 45.8 +/- 1.1 years, BMI 35.7 +/- 0.4 kg/m2) patients enrolled in a hospital based programme (MOS).
Main Outcome Measures:
Relative and absolute weight loss and retention rate were compared between the programmes at 10 and 26 weeks. Food habits were assessed at enrolment and week 10 of the programme in the SC group by a Food Habits Questionnaire and cognitive restraint, disinhibition and hunger were assessed by the Eating Inventory Questionnaire.
Results:
Shared Care patients (n = 28) lost significantly more weight than the MOS patients (n = 60) (SC 4.8 +/- 0.6 kg and MOS 2.6 +/- 0.4 kg; p = 0.0016) over the 10 weeks of the programme. At 26 weeks both groups demonstrated a 5 kg weight loss. There was a significant improvement in food habits, and cognitive restraint, disinhibition and hunger over the 10 weeks of the programme in the SC group. Patient satisfaction was reflected in a better retention rate at 26 weeks by the Shared Care group.
Conclusion:
The study demonstrated that the obese patient managed in a shared care setting achieved better weight loss in the short term and attrition was lower in the longer term than a similar patient attending a specialist service based in a hospital.