Objectives: A Healthy Lifestyle in Primary Care Group was established in November 2015 comprising 9 staff from Cavan/Monaghan Primary Care Physiotherapy Service. This was in response to an increasing number of referrals to the physiotherapy service for the management of obesity and an awareness amongst the staff of the increasing incidence of overweight and obese clients that were presenting to physiotherapy with varying musculoskeletal conditions.
The aim of the group was to develop a strategy that could be delivered within existing resources to clients attending the primary care service to improve their health and wellbeing.
Methods: The Royal College of Physicians of Ireland in 2014 recommended that “every interaction with a health professional is an opportunity to engage with a client or patient in relation to health and weight issues”. Using the ethos of “Making Every Contact Count” and the Weight Management Treatment Algorithm devised by the ICGP and HSE the following actions were implemented:
- Since February 2016 all clients attending for an initial assessment to physiotherapy are offered a BMI measurement.
- Weight, height, BMI and waist circumference are recorded on the patients database chart. Patients with a BMI greater than 25 have a sticker applied to their chart to allow identification of these patients in the future if specific resources were available in Primary Care to manage the problem of obesity.
- In March 2016 2 staff members from the group attended HSE training on Stages of Change and disseminated information to all Primary Care staff on how to assess readiness to change.
- Based on BMI and Stages of Change assessment appropriate advice is then provided to patients in the form of very brief interventions.
- The following brief interventions have been devised by the group
- Recommended daily activity levels
- Advice on diet and alcohol intake (devised in collaboration with dietetics service in Primary Care).
- Information on suitable apps and local resources individual to each Primary Care Team to support a healthy lifestyle.
- “Weight matters when it comes to joint pain” information leaflet.
- On discharge the above information is included in the discharge summary to the patients GP to allow the issue to be addressed by their GP going forward.
Results: The result of the work completed to date is that all staff working in Cavan/Monaghan Primary Care have been provided with the knowledge and tools to identify patients that are an unhealthy weight and have the appropriate information to provide to their patients to encourage a healthier lifestyle.
- Develop audit tool to include age, gender, BMI, physical activity levels and co-morbidities.
- Audit charts to determine uptake of BI's/BMI measurement.
- Develop retrospective patient questionnaire to determine impact of BI's
Conclusions: The RCSI Policy Group on Obesity 2014 lists physical activity advice/prescription and solutions for barriers to mobility as one of the core elements for weight management training required amongst health professionals. As physiotherapists based in Primary Care we have the expertise to deliver this information to patients and this combined with additional resources as documented above ensures that each contact is maximised to prevent and manage overweight and obesity.
1- Royal College of Physicians of Ireland, The Race we don't want to win, Tackling Ireland's Obesity Epidemic, 2014.
2- Royal College of Physicians of Ireland Policy Group on Obesity, 2015.