Implementing the 5As for management of obesity in Australian general practice

Context: Obesity is a major contributor to burden of disease and occurs in more than a quarter of primary care patients in Australia. The 5As framework (Assess, Advise, Agree, Assist and Arrange) has been adopted in national guidelines for the clinical management of overweight and obesity. However, implementation of this approach has been poor related to both patient and provider barriers. Objective: To evaluate the impact of an intervention designed to improve implementation across the 5As in general practice. Design: Cluster RCT of weight management for obese patients. Setting: Australian General Practice Participants: GPs and Practice Nurses (PNs) and their patients aged 40-70 years, without chronic disease with a BMI >29.9. Intervention: practices reviewed clinical audit data, training and practice visits. PNs were supported to conduct health checks based on the 5As including referral navigation. Data collection and analysis: Provider and patient reported assessment, education and referral and change in patient reported diet and physical activity and measured weight at 12 months. Univariate and multivariate analysis. Results: Interventon group providers reported improved frequency of advice and assisting referral. 163 patients were enrolled. At 6 months, intervention group patients reported improved frequency of assessment of waist circumference (72%), advice (58%) and referral for weight management (37%) compared to those in the control group (23%, 16%, and 0% respectively)(p