Australian GP’s need help to identify and manage obese patients

Australian GP’s need more support to help them meet national guidelines to tackle obesity, according to research by Monash University and published in the Medical Journal of Australia. The study, “Obesity management in general practice: does current practice match guideline recommendations?” reports that GP’s are not routinely recording measures of obesity, as recommended by the National Health and Medical Research Council (NHMRC).

Researchers did the study to assess the documentation of measures recommended in the NHMRC clinical guidelines for managing overweight and obesity in adults, adolescents and children in Australia.

Data was gathered from 270,426 adult patients from the Melbourne East Monash General Practice from general practice clinics located in the inner-eastern Melbourne region between July 2011 and December 2013. The guidelines suggest that routinely documenting obesity indicators such as BMI and waist circumference, are some of the quantitative measures that support a systematic approach to preventing and managing obesity.

Researchers discovered that only 22 percent (59,987) of patients had their BMI recorded, and just four percent (11,684) of patients had their waist circumference recorded. “The NHMRC guidelines emphasise the importance of patient engagement when it comes to managing and preventing obesity. Yet the low rates of documentation of obesity measures imply a continued need for programmes of support to increase obesity screening and documentation of related clinical information,” said study lead, Dr Lyle Turner from the Department of General Practice.

“Primary health care is generally the first point of contact for people seeking health services. So we know it has the potential to play a crucial role in helping identify and manage patients with obesity. Yet our data shows this isn’t happening as much as it could be.” Patients aged over 75 years were more likely to have a BMI recorded, but women overall were less likely to have measures of obesity documented. Patients with diabetes, hypertension or hyperlipidaemia and those who were prescribed diabetes-related medications were more likely to have a documented BMI.

Turner said the study identified potential hurdles GPs faced in increasing screening for obesity in general practice. “Problems in identifying obesity in the patient, difficulty discussing obesity, a perceived lack of appropriate training and clinical software restrictions, were common factors,” he said. “Primary care organisations assigning practice liaison officers to generate regular feedback on data quality and population-level health indicators, could be one way in which to tackle this, but more research is needed.”

The next step for this research will now be to talk with GPs directly, in order to identify the current barriers to recording of BMI and waist circumference. This will then inform strategies designed to increase the recording of these important measurements.

“By examining routine general practice data, we found that further support is needed to improve levels of screening for obesity and overweight in Australian general practice,” the study concludes. “Continued research is required to assess how documentation of obesity related clinical information changes over time as the NHMRC guidelines on managing overweight and obesity become embedded in clinical practice, and to examine barriers and enablers to increased obesity screening. To improve the quality of patient care, GPs should be supported to increase levels of obesity screening in accordance with the NHMRC.

Reference: Medical Journal of Australia 2015; 202 (7): 370-372 doi:10.5694/mja14.00998

Authors: Lyle R Turner, Mark F Harris and Danielle Mazza