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Counterweight Programme

Counterweight Programme. Counterweight Project Team Maria Dow September 2011. Agenda. Counterweight model Original evaluation 2000-2005 Project to established practice 2006-2011. Audit/Needs Assessment setting priorities. Practice Training setting guidelines. Evaluation

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Counterweight Programme

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  1. Counterweight Programme Counterweight Project Team Maria Dow September 2011

  2. Agenda • Counterweight model • Original evaluation 2000-2005 • Project to established practice 2006-2011

  3. Audit/Needs Assessmentsetting priorities PracticeTrainingsetting guidelines Evaluation improvingperformance Intervention Programmemeasuring performance Counterweight Model J Hum NutrDietet. 2004; 17: 191-208 Eur J ClinNutr. 2005; 59 Suppl 1: S93-101 Br J Gen Pract. 2008; 58: 548-554

  4. The Counterweight Project • Evidence-based model for obesity management • Evaluated in primary care • Competency based training and mentoring • Clinically significant, cost effective • Ongoing programme enhancement using continuous improvement methodology

  5. The Counterweight Project • Project board includes 7 national opinion leaders on obesity • Specialist team of 12 dietitians/nutritionists facilitate programme implementation • Independant evaluation team for data analysis and statistics

  6. Intervention • BMI ≥ 30 or 28 kg/m2 with co-morbidity • 6 appointments /group sessions over 3 months • 10-30 min appointments /1 hr group sessions • Weight loss maintenance • Quarterly review then annual • Aim minimum of 25 patients/year per practice J Hum NutrDietet. 2004; 17: 191-208

  7. Education materials J Hum NutrDietet. 2004; 17: 191-208

  8. Original evaluation 2002-2005 • 56 practices • 1906 patients • Mean BMI 37kg/m2 • Mean age 49 years • 77% patients female • 25% patients had BMI ≥ 40kg/m2 • 74% patients had ≥ 1 co-morbidity Br J Gen Pract. 2008; 58: 548-554

  9. Expected weight change without intervention Heitmann BL & Garby L (1999) Int J Obes Weight change attenders 3 2 1 0 24 m 3m 6m 12m -1 Weight Change kg Counterweight mean weight change -2 -3 -2.3 -3.0 -3.3 -4 -4.2 One in 6 achieve >5% weight loss at 12 or 24 months -5 n (12m) = 642 attending from total possible 1419 (45%) n (24m) = 357 attending from total possible 825 -6 Mean Counterweight effect size: 4 kg below expected weight at 12-24 months Br J Gen Pract. 2008; 58: 548-554

  10. Weight change attending population % of Patients n=642 Br J Gen Pract. 2008; 58: 548-554

  11. Weight change all patients % of Patients n=1419, NB 12m reported quit rate for patients attending stop smoking services = 7% Br J Gen Pract. 2008; 58: 548-554

  12. Used model developed for National Institute for Health and Clinical Excellence (NICE, 2006) Considers impact of the 12 month observed outcomes of the Counterweight Programme Assume no impact on the non-attending 55% Scenarios considered: Base case: weight lost is regained over the next two years Best case: weight loss is maintained over the individual’s life Both of these then revert to 1 kg/year usual weight gain in obese population Counterweight cost effectiveness

  13. Illustration of scenarios X = Baseline. Y= 12 months with Counterweight intervention Base case scenario = Regain all 4 kg weight difference effect in 2 yrs Best case scenario = Life-long maintenance of 4 kg weight difference No intervention - gain 1kg/y X Base case scenario Best case scenario Observed 2-year mean weight loss -2.3 kg (from baseline) Y International Journal of Clinical Practice (2010); 64(6), 775-783

  14. Even based on very limited estimates of the costs of obesity, and conservative benefit of Counterweight linked to DM, CHD, colon cancer the programme is highly cost-effective for UK NHS In the medium-long term, providing Counterweight in routine Primary Care will lead to cost savings from reduced medical consequences of obesity Health economic summary International Journal of Clinical Practice (2010); 64(6), 775-783

  15. Project to established practice • Scottish Government funding from 2006 • Implementation in 3 waves 2006-2008 • Waves 1, 2 implemented alongside Keep Well (CVD risk reduction)

  16. Patient characteristics Family Practice In Press

  17. Established practice patients enrolled Family Practice In Press

  18. Attendance Family Practice In Press

  19. Attendance Family Practice In Press

  20. Weight loss in attenders Family Practice In Press

  21. Weight loss in attenders n=3071 n=1775 n=928 Family Practice In Press

  22. Weight loss in all patients Family Practice In Press

  23. Motivators for programme adoption • Government policy and political drive • Engagement with primary care, obesity strategic teams, public health, dietetics • Dovetail with established local programmes • Link with clinical problems • Feedback of outcomes Family Practice In Press

  24. Conclusion The Counterweight Programme continues to demonstrate consistent outcomes in UK primary care

  25. Counterweight Project Team Counterweight Team Hazel Ross, Louise McCombie, Paula Noble, Marney Quinn, Maria Dow, Sarika Mongia, Frances Thompson, Anna Bell-Higgs, Naomi Brosnahan, Anne Clarke, Paula Regan, Adri Vermeulen, , Felicity Lyons (< April 2011), Sarah Haynes (< Dec 2010), Rachel Laws (<Jan 2007), Jenny Brown (<Dec 2006), Helen Gibbs (<Jul 2003) National Counterweight Board Prof. Iain Broom, Prof Nick Finer, Prof Gary Frost, Dr David Haslam, Prof. Sudhesh Kumar, Prof. Mike Lean, Prof. John Reckless IT and Statistics Billy Sloan, Philip McLoone, Dr David Morrison, Prof David Hole (<April 2006)

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