Randomised controlled trial and economic evaluation of a task-based weight management group programme
Randomised controlled trial and economic evaluation of a task-based weight management group programme
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DOI：
10.1186/s12889-019-6679-3
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发表时间：
2019-04-02
影响因子：
4.5
通讯作者：
Smith, Katie Myers
中科院分区：
文献类型：
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作者：
McRobbie, Hayden;Hajek, Peter;Smith, Katie Myers
背景：肥胖是一个日益严重的全球健康威胁，也是健康不平等的主要原因。我们需要有效、经济、覆盖弱势群体的体重管理计划。我们研究了一个多模式的小组干预是否结构，以满足来自弱势群体的客户方法：在这项随机对照试验中，从伦敦的普通诊所招募了330名肥胖成年人，并将其分配到（2：1）WAP（N=221）提供了八个每周小组会议或PNI（N=109）谁收到四个会议超过八周。这两项干预措施都涉及饮食、体育活动和自我监测。主要结局是12个月时体重较基线的变化。为了表明价值的NHS，成本效益分析估计组差异的成本和质量调整后的生命年（QOLS）相关的WAP.Results：参与者被招募2012年9月至2014年1月与后续完成2015年2月。大多数参与者没有有偿工作，60%来自少数民族。每个研究组中88%的参与者提供了至少一个记录的结局，并被纳入主要分析。与PNI相比，WAP总体上与更大的体重减轻相关（-4.2kg vs. -2.3kg;差异=-1.9kg，95% CI：-3.7至-0.1; P = 0.04），并且更有可能在12个月时产生至少5%的体重减轻（41%vs27%，OR = 14.61 95%CI：2.32 ~ 91.96，P = 0.004）。与增量成本效益比（ICER）的7742磅/QALY，WAP将被认为是高度成本效益相比，PNI.Conclusions：在这项研究中评估的任务为基础的方案可以提供一个模板，一个有效的和经济的方法来管理体重，可以达到客户从弱势群体。
Background: Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groupsare needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI).Methods: In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N=221) delivered over eight weekly group sessions or PNI (N=109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP.Results: Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (-4.2kg vs. -2.3kg; difference = -1.9kg, 95% CI: -3.7 to -0.1; P = 0.04) and was more likely to generate a weight loss of at least 5% at 12months (41% vs. 27%, OR = 14.61 95% CI: 2.32 to 91.96, P = 0.004). With an incremental cost-effectiveness ratio (ICER) of 7742 pound/QALY, WAP would be considered highly cost effective compared to PNI.Conclusions: The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities.