title: Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial.
abstract: BACKGROUND
  Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour.
  
  
  METHODS
  The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program.
  
  
  CONCLUSIONS
  The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care.
  
  
  BACKGROUND
  NCT01967797.
authors.affiliation: Department of Family Medicine, Clinical Research Unit, University of Alberta, 2-004 Li Ka Shing Ctr, 87 Avenue and 112st, Edmonton, AB T6G 2E1, Canada. dlcampbe@ualberta.ca.
authors.forename: Denise L
authors.initials: DL
authors.lastname: Campbell-Scherer
authors.forename: Jodie
authors.initials: J
authors.lastname: Asselin
authors.forename: Adedayo M
authors.initials: AM
authors.lastname: Osunlana
authors.forename: Sheri
authors.initials: S
authors.lastname: Fielding
authors.forename: Robin
authors.initials: R
authors.lastname: Anderson
authors.forename: Christian F
authors.initials: CF
authors.lastname: Rueda-Clausen
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Ayodele A
authors.initials: AA
authors.lastname: Ogunleye
authors.forename: Andrew
authors.initials: A
authors.lastname: Cave
authors.forename: Donna
authors.initials: D
authors.lastname: Manca
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
mesh_terms: D015992:Body Mass Index; D002170:Canada; D002985:Clinical Protocols; D003299:Cooperative Behavior; D003657:Decision Making; D019468:Disease Management; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D009765:Obesity / Q000175:diagnosis* / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D011788:Quality of Life; D012107:Research Design