How can referrals of patients who are obese to the local exercise referral scheme be increased? A UK based primary care quality improvement study

Abstract

BackgroundObesity is classified as a body mass index (BMI) >30kg/m2 and contributes to poor health outcomes in the UK. In 2017–18, obesity resulted in 711,000 hospital admissions. The National Institute for Health and Care Excellence (NICE) recommends GPs educate patients who are obese and refer them to exercise programmes. Our practice, Brierley Park Medical Centre, (NHS Mansfield and Ashfield CCG) is in a 4th decile most deprived region of North Nottinghamshire (UK) and serves a population of 9,288. The local exercise referral scheme (ERS) allows clinicians to refer patients to the local gym for a reduced fee at the point of access.AimTo calculate and increase the number of adult patients who are obese in our practice who are referred to the local ERS.MethodThe number of adult obese patients who were referred to the local ERS scheme from October 2018 to September 2019 was calculated. An intervention comprising internal system alerts, GP education utilising Making Every Contact Count framework and targeted patient group text alerts was designed and delivered. Pre (cycle 1) and post (cycle 2) intervention data from November to February were generated and compared.ResultsIn total, 2766 adult obese patients (29.8% of practice population) were identified: 16 (0.2%) patients were referred to ERS during cycle 1.96 (1%) patients were referred during cycle 2.ConclusionThe interventions that we have designed and implemented have increased the number of referrals to ERS and may be applied to similar primary care settings.

A qualitative exploration of the views of paramedics regarding the identification of cardiovascular risk factors in the pre-hospital environment

“…Reddy (2006) outlined guidance for obesity referral pathways in primary care, but there is no accessible alternative for an equivalent in the pre-hospital environment. Zaver (2020) also described exercise referrals that are being introduced to primary care. However, these are only accessible through a primary care practitioner, rather than directly from the pre-hospital environment.…”