Perceptions of clinical leaders and managers of inpatients with obesity in an Australian public health service

Abstract

Background: In 2014-15, 63.4% of Australian adults were overweight or obese, with 25% categorized as obese. Internationally, people with obesity are reported to experience inadequate quality of care, increased length of stay, more adverse events and higher costs of care. There are unique challenges associated with ensuring this cohort is provided with safe care which promotes their personal dignity. The aim of this study was to describe the experience of clinical leaders and managers of care provision to people with obesity, during inpatient admissions to an Australian public health service.Methods: A purposive, convenience sampling method was utilised, resulting in the recruitment of 17 participants. Data was collected via semi-structured interviews in the workplace, which were all digitally recorded for verbatim transcription. All data was subjected to thematic analysis, with identified codes reorganised into overall themes.Results: Five overarching themes were identified, four of which are discussed in this publication. The main themes and subthemes were (I) resource allocation (incorporating inequality, economic resources, human resources and physical resources); (II) service context (incorporating understanding 'bariatric', physical/ built environment, staff knowledge and skills, and organisational culture; (III) care transitions (incorporating transitions in care, communication and organisational processes; and recommendations for best care for people with obesity. Conclusions:The experience and perceptions of participants reflect the issues they prioritised in their respective roles, and confirm that providing care for people with obesity has significant policy and practice implications. These issues cannot be considered in isolation, with significant overlap and interdependence was evident. Participants also described the positive outcomes and progress which could be achieved when organisations take direct action to improve the care they provide to people with obesity.

Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting—A Point Prevalence Study

“…Despite the significant proportions of inpatients who are overweight and obese in the acute care setting, treatment is largely limited to surgical intervention [ 53 ], as primary care is the preferred setting for first-line treatments [ 54 ] and behavioral weight management interventions [ 55 ]. There is a reluctance by health professionals to raise obesity and weight as an issue with patients [ 56 ], and clinicians, including dietitians [ 57 , 58 , 59 ], may hold implicit negative attitudes and beliefs toward patients who are overweight or obese [ 56 , 60 ]. There are also challenges in care provision.…”

“…Patients who have obesity may need specialist support from treating teams, from continence specialists, respiratory physicians, wound care nurses, clinical psychology, and occupational health and safety representatives [ 60 ]. Health services need to ensure they have appropriate governance frameworks, leadership, policy, clinical pathways, and equipment [ 56 , 60 , 61 ] in place that support the best care of patients who have obesity as well as treating teams that are empathetic and are able to provide personalized care [ 56 , 60 , 62 ]. As a starting point, this may require an exploration of nutrition risks identified for patients in the hospital setting.…”