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Table 3 Differences in perceptions across the health system

From: The obesity paradigm and the role of health services in obesity prevention: a grounded theory approach

  EXECUTIVE: Macro CLINICAL MANAGERS: Meso CLINICIANS: Micro
PURPOSE Population health with solution focus Specific clinical groups with process focus Individual needs – solution focus on individual systems
INTER-RELATIONSHIPS KEY SOURCE OF FEEDBACK Population health data Observations of time and resources required to manage individual patient Limited interdisciplinary feedback
ASSUMPTIONS Primary care will address obesity Dietitians will weigh people and lead on weight loss to address obesity Need to have rapport with person before can raise weight
HAVING THE CONVERSATION Communication about obesity needs to be at a population level Obesity is a taboo topic and can only be discussed if the individual patient wants to discuss Need to have rapport and would only discuss weight with a patient as linked to presenting health issue
PERSPECTIVES CONCERN (IN RELATION TO OBESITY) Physical demands (extra staff/extra equipment/ increased level of service) of caring for people with obesity in hospital and implications for resources Managing practical issues relating to caring for people with obesity
e.g. equipment, double handed visits
Not being able to do enough to address breadth of reasons for why an individual may be obese plus obesity impacting on effectiveness of treatment for presenting problem
ROLE OF HEALTH IN PREVENTION Individual prevention is futile, need population approach Health theoretically has a prevention role BUT too busy providing treatment Try to do opportunistic prevention with patients – feel they have duty of care
WEIGHING PATIENTS Clinicians should weigh patients Have ensured bariatric weighing equipment is available but do not consider impact of weight in planning of services Do not routinely weigh patients and many feel shouldn’t weigh patients
BOUNDARIES WHAT LIMITS PREVENTION Political will to make large scale and legislative changes Complexity of patients Service criteria/scope of practice
POLICY Responsible for policy – focus on population level and health staff Aware of policy but it does not impact on the service criteria/clinical focus Unaware of policy to direct clinical care but are looking for guidance
CLINICAL FOCUS Moving healthcare from hospital to community/ reducing hospital demand Providing services that can manage complex needs Providing care within service criteria and scope of practice (obesity prevention not in any service criteria)
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