Perspectives of clinicians and patients on community-based maintenance care for adults with obesity

Abstract Background Tertiary metabolic health services are in high demand as people with severe obesity increase. Once predetermined health goals have been achieved patients must transition to community-based care to urgently free up capacity in tertiary services. Maintenance of successful outcomes achieved via tertiary services is therefore important to limit rates of relapse back to these services. Methods This qualitative project explored community-based care needs to help individuals living with obesity maintain health gains. An interview schedule guided one-on-one interviews with patients and staff from metabolic clinics in Sydney, Australia. Results We interviewed 22 patients and 13 clinicians. A lack of appropriate and consistent clinical support in the community was identified by patients and clinicians. Most clinicians agreed primary care was key to successful maintenance care. Lack of primary care understanding of appropriate management and support for patients with obesity, lack of bariatric equipment and limited funding for allied health were all seen barriers to appropriate support beyond their clinics. Patients were highly reluctant to transition from tertiary clinics and reluctant to engage with community-based care due to experience of limited clinical/social support and bariatric equipment, demeaning clinical interactions, lack of care coordination and being stigmatised. Support groups outside of the clinic were also identified important in mitigating social isolation and stigma. Both patients and clinicians felt support groups have potential to provide important supplementary help to individuals with obesity outside tertiary settings. Conclusions Currently, individuals aiming to maintain their weight are likely to struggle in the context of existing community care provisions. Integrated, community-based and affordable models of care are needed now to allow tertiary metabolic services discharge their patients safely. Key messages • Tertiary obesity services are at capacity. • Subsequent community care for people wth obesity needs to be mote appropriate tp promote weight maintenance.


Background:
Hip replacement is a common orthopaedic surgery procedure that produces great improvement in the quality of life.Despite this, a globally standardized post-operative physiotherapy protocol still does not exist.The aim of this study is to identify the factors that influence the motor and functional outcome after early, intensive, hospitalized treatment.Methods: A retrospective study was conducted in 2019 on 509 patients admitted to an Italian private clinic specialized in post-surgery rehabilitation, which applies an original bio-psycho-socialenvironmental protocol and individual rehabilitation plans.Data regarding each patient were collected from medical records: age, haemoglobin, Body Mass Index (BMI), Cumulative Illness Rating Scale (CIRS), Tinetti scale (TS) and Barthel scale (BS) at admission and discharge.The outcome was measured as the difference (Á) between the values at discharge and admission of BS (ÁBS) and TS (ÁTS).We performed a univariate linear regression using STATA, to determine which factors influence the outcome.A p < 0.05 was considered statistically significant.

Conclusions:
Patients with worse health conditions, advanced age and lower motor performance at admission obtain a higher outcome.

Background:
Tertiary metabolic health services are in high demand as people with severe obesity increase.Once predetermined health goals have been achieved patients must transition to community-based care to urgently free up capacity in tertiary services.Maintenance of successful outcomes achieved via tertiary services is therefore important to limit rates of relapse back to these services.

Methods:
This qualitative project explored community-based care needs to help individuals living with obesity maintain health gains.An interview schedule guided one-on-one interviews with patients and staff from metabolic clinics in Sydney, Australia.

Results:
We interviewed 22 patients and 13 clinicians.A lack of appropriate and consistent clinical support in the community was identified by patients and clinicians.Most clinicians agreed primary care was key to successful maintenance care.Lack of primary care understanding of appropriate management and support for patients with obesity, lack of bariatric equipment and limited funding for allied health were all seen barriers to appropriate support beyond their clinics.Patients were highly reluctant to transition from tertiary clinics and reluctant to engage with community-based care due to experience of limited clinical/social support and bariatric equipment, demeaning clinical interactions, lack of care coordination and being stigmatised.Support groups outside of the clinic were also identified important in mitigating social isolation and stigma.Both patients and clinicians felt support groups have potential to provide important supplementary help to individuals with obesity outside tertiary settings.

Conclusions:
Currently, individuals aiming to maintain their weight are likely to struggle in the context of existing community care Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care.Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas.Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices.How does French model of MAs impact quality and productivity in GPs' practices and articulate with other policies?We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs' work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews).MA was defined as a function centered on physicians' needs, accessible both to administrative staff and nursing professions.MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management.Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise.In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity.However, for most GPs, it primarily helped them to maintain high workload without burning out.Although MAs with clinical background seem better suited for patients' needs, recent figures have shown that more than half of MAs employed are former secretaries.If inperson secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals.Other aspects than productivity must be taken into account in a support policy.

Key messages:
Regardless of productivity objectives to attain, hiring MAs can relieve physicians' workload and stress, preventing them from burning out and guarantee access to care in deprived areas.
MA's clinical profile could have a stronger impact on public health issues such as chronic disease care management.
We employed a cross-sectional comparative study using two different time periods, the prepandemic (March 2019 to February 2020) and the pandemic (March 2020 to February 2021) to explore possibilities of COVID-19 pandemic influence on hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County.The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split.The ACSCs 15th European Public Health Conference 2022