Evaluating the management of obesity in UK primary care

研究背景：由于大多数英国人患有肥胖症及其并发症，体重管理是公共卫生和初级保健的一项重大任务。与其他与生活方式有关的慢性疾病不同的是，自2004年以来，这些疾病的监测和管理一直通过结果质量框架指标来激励，肥胖症的管理并没有以类似的方式迅速得到优先考虑。尽管英国医学会在2020年不情愿，但英国国家医疗服务体系(NHS)现在已经在2021年推出了一项政策，将初级保健中体重管理计划的转介货币化。其目的和目标：这个项目的目的是了解国家增强服务激励(NESI)对英国普通外科手术体重管理的影响。使用混合方法，将通过观察转介数量、提供的体重管理建议、体重、血糖、血压、精神健康发生率的变化，以及初级保健人员在实施NESI后对体重管理的看法、态度和想法的变化来衡量影响。它的潜在应用和好处：该项目的一个近期好处是与主要利益攸关方合作，同时进行评估和实施。通过这项工作，我们将在与NHS的实施团队密切合作评估该政策时向NHS提供直接反馈，以潜在地在该计划推出时对其进行完善。更长远地说，这项工作将提供对旨在激励体重管理的国家计划的效用的洞察，这可能会影响未来的政策。此外，该项目与MRC-UKRI的七个战略优先事项中的四个相联系：1)预防和早期发现，2)多病，3)精确医学和4)精神健康，这些共同支持优秀的发现科学，以改善人类健康。从前两个主题开始，体重管理属于预防的范畴，通过瞄准健康不良的上游原因，可以先发制人，预防肥胖的风险因素，如糖尿病、心血管疾病和某些癌症，我们将使用大数据评估对共病的影响。第三，NESI计划承认患者的个性，让他们可以选择体重管理计划，以满足他们的独特需求，我们希望从患者的角度理解这一特点的重要性。最后，我们假设在我们的评估中采用生物心理社会方法，并认识到心理健康和肥胖之间的相关性。我们将好奇地看到更多地参与体重管理的影响，以及这可能如何影响心理健康，即焦虑和抑郁。

The context of the research: With the majority of the UK population living with obesity and its complications, weight management is a momentous task for public health and primary care. Unlike other lifestyle related chronic conditions whose monitoring and management have been incentivised through the Quality of Outcomes Framework indicators since 2004, the management of obesity has not been promptly prioritised in a similar fashion. Despite reluctance from the British Medical Association in 2020, the National Health Service (NHS) has now introduced a policy in 2021 to monetise referrals to weight management programmes in primary care. Its aims and objectives: The aim of this project is to understand the impact of the National Enhanced Service Incentive (NESI) on weight management in UK general surgeries. Using a mixed methods approach, impact will be gauged by observing changes in the number of referrals, weight management advice given, weight, blood sugar, blood pressure, incidence of mental health, and changes in the perceptions, attitudes, and thoughts on weight management by primary care staff on the heels of the implementation of NESI. Its potential applications and benefits: A proximal benefit of this project is the collaboration with key stakeholders for simultaneous evaluation and implementation. Through this work, we will provide direct feedback to the NHS as we evaluate the policy in close collaboration with their implementation team, to potentially refine the scheme as it is rolled out. More distally, this work will provide insight into the utility of national programmes aiming to incentivise weight management, which may influence future policy. Additionally, this project ties in four of the MRC-UKRI's seven strategic priorities; 1) prevention and early detection, 2), multimorbidities, 3) precision medicine and 4) mental health, which collectively support excellent discovery science to improve human health. To begin with the first two themes, weight management falls within the remit of prevention, by targeting an upstream cause of ill-health, which can pre-empt the risk factors of obesity such as diabetes, cardiovascular disease and certain cancers, and we will evaluate the impact on comorbidities using big data. Thirdly, the NESI scheme recognises the individuality of the patient, allowing for choice in selecting the weight management programme to meet their unique needs, and we hope to understand the importance of this feature from the patient perspective. Finally, we assume a biopsychosocial approach in our evaluation, and recognise the correlation between mental health and obesity. We will be curious to see the influence of increased engagement with weight management, and how this may influence mental health, namely anxiety and depression.