BN 72_Impact of 5AsT intervention on weight

Impact of 5AsT Interven-on on Weight Management in a Primary Care Network
Campbell-­‐Scherer D1, Ogunleye A A1,2, Anderson R3, Osunlana A M2, Asselin J1,2, Cave A1, Sharma A M2. University of Alberta Department of Family Medicine1 & Department of Medicine2; and Edmonton Southside Primary Care Network3 . Background Obesity is not effec-vely managed within primary health system, and we observe low rates of obesity/weight management visits in primary care. The 5As Team Study (5AsT) is a RCT with convergent mixed methods evalua-on. The interven-on was co-­‐created with end-­‐users, and aimed to change provider behaviour to increase the number and quality of weight management visits. Here we evaluate the impact of 5AsT interven-on on the frequency of weight management conducted by healthcare providers in the member clinics of a primary care network (PCN). Quan%ta%ve Methods 24 Clinic Teams Randomized – Registered Nurses/Nurse Prac--oners, Die-cians, Mental Health Workers received a six month interven-on with other mul-disciplinary primary care providers ( 12 biweekly learning sessions). Figure 1: 5AsT study methods Alloca%on Concealed, Randomized, Blinding (outcome measure from data analyst)
Table 1: Median and interquar-le ranges of par-cipants characteris-cs. Age Clinic size (years) (Oct. 2013) Control: Median 49.5 7141 (IQR) (17) (10317) Interven-on: Median 44.0 5976 (IQR) (21) (6595) FTE Encounter/ Encounter/
FTE FTE/ Total Ac%vity 0.98 28.00 0.05 (0.43) (31.67) (0.05) 0.86 7.38 0.03 (0.48) (20.37) (0.07) Encounter Complete admin Primary data analysis on all Inten%on to par%cipants; Treat Rou%nely Collected Primary outcome Frequency of weight management per FTE Planned secondary analyses per protocol aSer mixing qualita%ve data •  One-­‐year pre-­‐interven-on frequency of weight management/FTE was compared with post-­‐interven-on values at five quarterly -me points. •  Generalized es-ma-ng equa-ons, with Poisson distribu-on, was used to es-mate the 5AsT interven-on effect on the adjusted frequency of weight management /FTE over -me in both groups. •  Interac-on between groups and the different follow-­‐up points was evaluated. 17.0 (29.0) 5.0 (11.0) Results •  Mann–Whitney U test shows there was no differences between the interven-on and the control arms at baseline (p=0.29). •  The result (Table 2) indicates a trend to rela-ve increase in visits rate is 36% higher in the Interven-on group than the control group (RR 1.36 (95%CI ( 0.90-­‐ 2.07)). •  In the control group, there was 0.13 decrease in the rate of visits; while in the interven-on group, there was an increase of 0.18 (-­‐0.13+0.31). This difference in slope was not sta-s-cally significant (p=0.14). •  Planned secondary analyses will further adjust for provider par-cipa-on in the interven-on. Figure 2: Adjusted study group encounter over -me. Table 2: Coefficients (95% Confidence intervals) of the GEE results. Variables in the GEE model treat Including overdispersion scale op%on -­‐0.29(-­‐1.26 to 0.68) postbaseline -­‐0.13(-­‐0.40 to 0.13) -­‐0.13(-­‐0.76 to 0.49) -­‐0.13(-­‐0.48 to 0.27) 0.87(0.67 to 1.14) treat*postbaseline 0.31(-­‐0.11 to 0.73) OmiNng Robust Regression Incidence Rate overdispersion for robust variance Ra%o (IRR) scale -­‐0.29(-­‐2.58 to 2.00) -­‐0.29(-­‐1.09 to 0.51) 0.75(0.28 to 1.97) 0.31(-­‐0.67 to 1.29) 0.31(-­‐0.32 to 0.94) 1.36(0.90 to 2.07) constant -­‐2.48(-­‐3.09 to -­‐1.87) -­‐2.48(-­‐3.93 to -­‐1.04) -­‐2.48(-­‐2.96 to -­‐2.00) 0.08(0.05 to 0.15) Ø 0.18 1 1 0.18 Figure 3: Adjusted provider’s encounter over -me by study groups Interven%on group Control group Conclusion We hypothesized that nurses randomized to the 5AsT interven-on would carry out a significantly higher number and improved quality of weight management visits compared to the control group. Although not sta-s-cally significant, we found that weight management encounters increased in the interven-on group following the 5AsT interven-on. Qualita-ve study data revealed that weight management is frequently bundled with other presenta-ons, which may limit the number of discrete weight management visits happening in our se\ng. The outcome of 5AsT interven-on may be important for wider dissemina-on to other primary care contexts. 5As: Ask; Assess; Advise; Agree; Assist. 5AsT: 5As of Obesity Management Team. RCT: Randomized Controlled Trial.
GEE: General Estimating Equation; CI: Confidence Interval; IQR: Interquartile Range.
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