Primary care practitioners (PCPs) are well placed to identify individuals with obesity and weight‐related comorbidities and to refer them to weight management services (WMS), but this does not often happen in practice. In this realist review, we searched six databases for intervention studies targeted at PCPs to improve the identification and referral of adults with comorbid obesity. Realist analysis was used to identify context‐mechanism‐outcome (CMO) configurations across 30 included papers (reporting on 27 studies). Most studies used multiple intervention strategies, categorised into: (a) training, (b) tools to improve identification, (c) tools to improve ease of referral, (d) audit/feedback, (e) working in networks/quality circles, and (f) other. The realist synthesis identified 12 mechanisms through which interventions work to improve identification and referral, including increasing knowledge about obesity and awareness of and confidence in WMS among practitioners, improved communication and trust between practitioners and WMS, and higher priority given to weight management among primary care teams. The theory of “candidacy” (a person's eligibility for medical attention and intervention) provided a robust explanatory framework but required refinement: (a) to take account of the different services (primary care and weight management) that patients must navigate to access support; and (b) to acknowledge the importance of wider contextual factors.

中文翻译：

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什么是有效的，以及为什么在初级保健中鉴定和转诊患有合并症的成年人：现实主义者的评论。

基层医疗从业人员（PCP）位置优越，可以识别患有肥胖和体重相关合并症的人并进行转介他们使用体重管理服务（WMS），但这在实践中并不经常发生。在此现实主义者的评论中，我们搜索了六个数据库以进行针对PCP的干预研究，以改善对合并症的成年人的识别和转诊。现实主义分析被用来识别30篇包括论文的情境-机制-结果（CMO）配置（报告27项研究）。大多数研究使用了多种干预策略，分为：（a）培训，（b）改进识别的工具，（c）改进转介容易性的工具，（d）审核/反馈，（e）在网络/质量圈工作， （f）其他。现实主义者的综合报告确定了12种机制，通过这些机制，干预措施可以改善识别和转诊的效果，包括增加对肥胖的了解以及从业者对WMS的认识和信心，改善从业者与WMS之间的沟通和信任，并更加重视基层医疗团队之间的体重管理。“候选资格”（一个人有资格获得医疗和干预的资格）理论提供了一个有力的解释框架，但需要完善：（a）考虑到患者必须导航以获取支持的不同服务（初级保健和体重管理）；（b）承认更广泛的背景因素的重要性。（a）考虑到患者必须导航以获取支持的不同服务（初级保健和体重管理）；（b）承认更广泛的背景因素的重要性。（a）考虑到患者必须导航以获取支持的不同服务（初级保健和体重管理）；（b）承认更广泛的背景因素的重要性。