Please select the eligibility criteria that correspond to the clinical trial below.
Title: Implementation and Validation of the "5As Framework of Obesity Management" in Primary Care. "5AsT"
Brief Summary: The main goal of this project is to develop, implement and evaluate the 5As Team intervention (5AsT)for healthcare practitioners to improve their weight management patient encounters and improve patient health outcomes. The 5As of Obesity Management suite of tools is a robust, evidence-based approach to weight management, however its implementation and uptake has been heterogeneous in primary care.

This project was co-created by, and will be implemented with, our partners the Southside Primary Care Network (SSPCN). A needs assessment on weight management by the SSPCN revealed the need to change provider practice to increase the number of weight management visits. Despite a robust didactic training session on weight management for all providers, which includes the 5As, the uptake in practice has been highly heterogeneous. Thus, the 5AsT intervention to address the implementation of the 5As of Obesity Management in clinical practice was developed by the collaborative team. The SSPCN consists of 25 autonomous groups of multidisciplinary professionals that provide service to a defined group of patients within the SSPCN.

The 5As Team consists of multidisciplinary providers (Registered Nurse/ Nurse Practitioner, dietician, mental health worker) who work collaboratively. The intervention is a learning collaborative where these 12 different 5AsTs get together to work to address facilitators and barriers to weight management in their settings over a 6 month period. Half of the teams (N=12) will remain as controls and deliver usual care. They serve as a comparison group for the 5AsTs. This mixed methods study's primary outcomes will assess the change in provider practice and the effectiveness of the intervention and implementation.

To assess the impact of 5AsT on patients, we will recruit patients presenting to the central SSPCN programming, We will not intervene directly on patients; we will observe the impact of the 5AsT and SSPCN programming on their health outcomes for a minimum of 6 months, and where possible for 18 months. Data collected includes demographics, weight (BMI), waist circumference, vital signs,and Short Form-12 (SF-12,these measures are routinely measured in the SSPCN), EuroQol-5 dimensions 5 Level (EQ-5D-5L), modified patient assessment of chronic illness (PACIC), and observed adherence to routine clinical care for guideline recommended laboratory monitoring (cholesterol panel, fasting glucose, HbA1c, where appropriate).


Options:
A: Inclusion Criteria:

* Enrolled as a pt in the VA Healthcare System
* screens positive for major depression
* has a scheduled visit at a primary care site taking part in the study

Exclusion Criteria:

* severe alcohol abuse
* psychosis
* dementia
* acutely suicidal (at screening)
* lack of access to or ability to use a phone
B: Inclusion Criteria:

* Must be staff or clinicians (including physicians, nurse practitioners, and physician assistants) in an enrolled primary care practice
* Primary care practices must be family medicine or general internal medicine practices with a maximum of ten lead clinicians
* Primary care practices must be either independent or, if part of a larger organization, demonstrate on careful screening that they do not receive significant quality improvement support from the larger organization

Exclusion Criteria:

* Primary care practices with more than 10 lead clinicians
* Non-independent primary care practices that receive significant quality improvement support from their system or organization
* Clinicians and staff who do not speak or read English
C: Inclusion Criteria:

* Adult patients over 18 years
* BMI ≥ 25
* Enrolling in PCN programs for overweight/ obesity or depression able and willing to give written informed consent in English

Exclusion Criteria:

* Children and pregnant women
* Patients whose obesity is co-managed by an obesity specialist or tertiary care center
* Patients who are unable to participate in regular clinic visits or programs due to geographic, social or physical reasons
D: Inclusion Criteria:

* Age ≥ 18 years
* Acute HF as a primary cause of hospitalization

  * Hospitalizations for acute HF will be determined by local clinician-investigators but should include the following:
  * Symptoms (eg, dyspnea, fatigue), signs (eg, elevated jugular venous pressure, peripheral edema), or laboratory/imaging evidence of HF (eg, pulmonary congestion on chest x-ray, elevated natriuretic peptide levels) during the hospitalization and
  * Treatments aimed at acute HF (eg, intravenous diuretics, vasodilators, or inotropes)
* LVEF ≤ 40% based on last local measurement using echocardiography, multigated acquisition scan, computed tomography (CT) scanning, magnetic resonance imaging, or ventricular angiography
* Planned discharge to home or other supported care facility where patients are individually responsible for medication management

Exclusion Criteria:

* Prior heart transplant or current/planned left ventricular assistance device
* Chronic kidney disease requiring dialysis
* Terminal illness other than HF, such as malignancy, or with a life expectancy of less than 1 year as determined by the enrolling clinician-investigator
* Unable to participate in longitudinal follow-up, such as plans to move outside the US in the following year

Answer: C