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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在初级保健中识别和转诊患有共病肥胖的成人时，什么有效以及为什么有效：现实主义评论。


初级保健医生 (PCP) 能够很好地识别患有肥胖和体重相关合并症的个体，并将他们转介给体重管理服务 (WMS)，但在实践中这种情况并不经常发生。在这篇现实主义综述中，我们检索了六个数据库，以进行针对 PCP 的干预研究，以改善对患有共病肥胖的成人的识别和转诊。使用现实分析来确定 30 篇纳入论文的背景机制结果 (CMO) 配置（报告 27 项研究）。大多数研究使用多种干预策略，分为：（a）培训，（b）改善识别的工具，（c）改善转诊便利性的工具，（d）审计/反馈，（e）在网络/质量圈中工作， (f) 其他。现实主义综合确定了 12 种机制，通过这些机制，干预措施可以改善识别和转诊，包括增加从业者对肥胖的了解以及对 WMS 的认识和信心，改善从业者和 WMS 之间的沟通和信任，以及在初级保健中更加重视体重管理团队。 “候选资格”理论（一个人获得医疗护理和干预的资格）提供了一个强有力的解释框架，但需要完善：(a) 考虑患者为获得支持而必须获得的不同服务（初级保健和体重管理）； (b) 承认更广泛背景因素的重要性。