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Note on Healthcare

Connecting is better than referring

This extremely informative study, “Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial” informs us in two different areas: the impact of directly connecting patients vs. just referring them to treatment programs, and the ability of a brief, practical, resource-efficient approach to have a significant clinical effect.

Connecting vs. referring – The AAR (Ask, Advise, Refer) model has been proposed as an approach to engage patients with different treatment programs, such as tobacco cessation programs. However, AAC (Ask, Advise, Connect) has been shown to be a much more potent approach, ask connecting rather than referring increased attendance dramatically, 40% vs. 9%. You might presume that those patients who were connected were less likely to engage or achieve success than those who were connected, but this was clearly not the case in this study and others. This is an important finding, as it means that, in these cases, there is no added benefit to determining how ready people are to make the change. You provide very brief advice (see example below), make a solid connection/appointment, and the patient and treatment program take over from there.

Practical approaches to obesity – A 30 second discussion about a weight loss support group produced impressive results, with most of the benefit coming from the group that was connected (appointment made with a local weight loss group covered by their medical insurance) rather than just referred.  The simplicity of the approach ensures its scalability. A typical ‘connection’ conversation went like this:

Physician: While you’re here, I just wanted to talk about your
weight. You know the best way to lose weight is to go to
[Slimming World or Rosemary Conley] and that’s available
free on the NHS?
Patient: Oh?
Physician: Yes, and I can refer you now if you are willing to
give that a try?
Patient: Yes, ok.
Physician: Ok, what you need to do is take this envelope back
outside to the person who weighed you and they will book
you into the weight loss course now.
Patient: Ok.
Physician: Good, but I’d like to see how you’re getting on, so
come and see me again in 4 weeks, please. Ok?
Patient: Ok, see you then.

The notable points are the briefness and simplicity of the interaction, which makes it practical, and the fact that the success rate of those who were connected by the office was similar to the success rate in people who were interested enough to make an appointment on their own. Another factor was the use of third party weight loss programs, which were reasonably priced and covered by medical insurance. This outsourcing technique has also been successful for smoking cessation and other medical problems.

This commentary nicely summarizes these points

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