The Counterweight Programme: Research Phase
BackgroundThe Counterweight Programme was launched in 2000 as the result of a national group of consultant physicians recognising the need to tackle obesity management in primary care. The National Counterweight Project Board was established for project guidance and management. Counterweight is a multi-centre practice nurse led obesity management project being conducted in 80 general practices in 7 regions of the UK; Aberdeen, Bath, Birmingham, Glasgow, Hammersmith, Leeds and Luton. There is a Weight Management Adviser (a dietitian with specialist training in obesity management) in each region to facilitate the process.
AimThe overall aim is to improve the management of obesity in primary care, thus reducing the disease burden of obesity in the population.
Objectives
StrategySeven Weight Management Advisers (WMAs) and a National Co-ordinator facilitate the implementation of the programme. The WMAs conducted a review of baseline medical practise, staff training, and then provided on-going support for the Practice Nurses for a minimum of 6 months.
Audit and Needs AssessmentThe WMA conducts audit in each practice. There are 2 parts to the audit: Firstly there is an audit of patient screening, equipment and patient education literature. Secondly there is a detailed patient audit in a random sample from each participating practice. The audit took a sample of 100 obese patients from each practice in the first five practices. In the second five practices 50 obese patients were randomly selected, then age and sex matched with normal weight patients for within practice comparisons. Data was gathered to achieve a comprehensive clinical picture on each patient including demographic characteristics, the screening for and recording of co-morbid conditions and NHS resource use including primary and secondary care contacts, hospital admissions and prescribing rates. There was a review of resource materials for patient and staff education.
Intervention ProgrammeThe intervention programme is a structured pathway for management of obesity in primary care consisting of screening and evidence-based treatment guidelines. WMAs conduct a 6 hour training programme for Practice Nurses. They then provide clinical support in the practice to assist the nurses in treating patients in weight management clinics, groups or opportunistically. An integrated package of patient education materials has been developed to support the Counterweight programme, and the WMAs work with the nurses to guide them on the implementation of the programme until the desired level of competency has been reached. The nurses are advised to see patients for 6 appointments of 10-30 minutes over a 3 month period (or in 6 group sessions lasting 1 hour) Patients are then followed up at least quarterly thereafter.
EvaluationWeight loss will be the primary way of evaluating the success of the pathway for the management of obesity in primary care. The number of patients reaching specified weight loss targets of 5% and 10% of initial body weight will be examined, as these weight losses are clinically beneficial. Secondary endpoints such as changes in blood pressure, lipids and diabetes control will also be assessed.
Benefits to Primary CareThe intervention programme offers the following:
Project SponsorsThis is a non-promotional five year project funded by a non incumbent educational grant in aid from Roche Products Ltd. It is managed by a clinician-led Project Board. There are no contractual obligations between the Counterweight Board and the sponsor.
Project GovernanceThe Counterweight Project Board includes membership of seven leading experts in the field of weight management from both academic or NHS clinical backgrounds (see list below). Other members of the board are the director of the West of Scotland Cancer Surveillance Unit (data and statistical analysts), the National Coordinator, two of the seven Weight Management Advisers, two representatives from the Project sponsors and a representative from the British Dietetic Association. All components of the project are formally agreed by the project board and the project chair and co-ordinator manage the Counterweight budget. Other attendees at board meetings have been/will include Department of Health, a qualitative research group, statisticians, data analysts and a Health Economist. The lead clinicians/academics receive no remuneration any of their work in the programme and the hospitals/universities provide a base for the WMAs.
Qualifications and Institutional Affiliation of Board LeadsProfessor J Broom, Mache, MRCP(Glas), FRCPath, Research Professor and Consultant in Clinical Biochemistry and Metabolic Medicine, The Robert Gordon University, School of Life Sciences, Aberdeen. Dr John Reckless, DSc MD FRCP, Consultant Endocrinologist and Hon. Reader in Medicine & Biochemistry, University of Bath, Royal United Hospital, Bath. Professor Sudhesh Kumar, MD FRCP, Professor of Medicine, Diabetes and Metabolism, Warwick Medical School, University of Warwick. Professor Mike Lean, MA, MD, FRCP, FRCPS, Glasgow University Department of Human Nutrition, Glasgow Royal Infirmary. Dr Gary Frost, PhD SRD, Head of Nutrition & Dietetic Service, SRD & Honorary Reader in Nutrition, Hammersmith Hospitals NHS Trust. Dr Julian H Barth, MD FRCP FRCPath, Consultant in Clinical Biochemistry and Immunology, Dept. of Clinicial Biochemistry and Immunology, Leeds General Infirmary, Leeds NHS Trust. Dr Nick Finer, FRCP, Consultant Endocrinologist, Centre for Obesity Research, Luton and Dunstable Hospital NHS Trust. Professor David Hole, MSc FFPHM, Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow. |