Lifestyle discussions in UK primary care: an analysis of consultations
Research type
Research Study
Full title
Addressing lifestyle behaviours in the management of diabetes and hypertension: an analysis of recorded primary care consultations
IRAS ID
293284
Contact name
Paul Aveyard
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
Consultations in general practice are complex, often dealing with multiple health problems that are discussed by GPs, nurses and their patients in various ways. In the UK, patients with chronic diseases including diabetes and hypertension are seen each year by their GP or nurse for a review of their medical condition. GPs and nurses have a key role in these consultations to support and advise patients on multiple lifestyle behaviours that are known to affect health, including diet, smoking, alcohol use and physical activity. The way that these consultations are carried out often changes when there is new guidance for how to manage a chronic disease. One such change that is likely to affect the way that diabetes and hypertension care are delivered, is the introduction of a new payment scheme for GPs and nurses in April 2021. The new scheme will pay GPs and nurses for referring patients with diabetes or hypertension who are living with obesity to NHS weight management services. This project seeks to understand whether this new guidance influences what lifestyle discussions take place during routine annual review consultations and the impact that the new guidance has on conversations about other lifestyle behaviours. In order to do this, we will audio or video record up to 100 consultations between GPs, nurses and their patients over a period of 12 months, before and after the new scheme is put in place. We will analyse the consultation recordings using content analysis, allowing us to categorise key elements of the consultation. We will also use conversation analysis to look more closely at the language used and how the patient responds to the advice given. The findings will be used to identify more effective ways of communicating and helping GPs/nurses address lifestyle advice with patients with diabetes and/or hypertension.
Summary of Results
Background: Guidelines recommend clinicians intervene when patients have obesity or a high waist circumference. Despite this, referrals to weight management services are infrequently offered by practitioners. To provide additional support to patients living with obesity and weight-related conditions, the government instated the National Enhanced Service for weight management (NES), including an incentive to reimburse practices for referring patients to weight management programmes.
Objective: To assess the impact of the NES on discussions about weight management between patients and their health care providers.
Methods: Eleven medical practices were recruited from England where the NES was operating and six comparator practices from Scotland and Wales where there was no NES. Clinicians audio-recorded annual review appointments of patients living with obesity and hypertension and/or diabetes. The content of these conversations was summarised.
Results: Consultations with ninety-two patients with obesity and a diagnosis of hypertension and/or diabetes were analysed, 58 in England and 34 in Scotland and Wales. No difference was found between the NES sites (England) and non-NES sites (Scotland and Wales) on the number of referrals made to weight management programmes. Clinicians in England weighed patients and took other body measurements more often, mentioned BMI more often, and had more detailed discussion about patients’ diets but did not differ in their discussion of weight management programmes or other behavioural risk factors.
Conclusion: We found no strong evidence that the NES affected consultation content relating to behavioural risk factors in annual review consultations for patients living with obesity and hypertension and/or diabetes.
REC name
HSC REC B
REC reference
21/NI/0048
Date of REC Opinion
2 Mar 2021
REC opinion
Further Information Favourable Opinion