Evaluating the Transferability of a Successful, Hospital-based, Childhood Obesity Clinic to Primary Care: a Pilot Study
Condition: Childhood Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Obesity affects one in five children in the UK and undoubtedly causes increased ill health
      with rising levels of childhood and adolescent diabetes, obesity induced liver disease and
      increased risk of early heart disease. There are few clinics offering effective treatment for
      childhood obesity. However, the clinic for childhood obesity at Bristol Royal Hospital for
      Children (BCH) has been successful in around 83% of cases. This pilot study aims to examine
      the feasibility of transferring the success of the hospital clinic to primary care in
      preparation for a full RCT. The study will entail training a practice nurse, community
      dietician and exercise specialist to deliver the same clinical service in primary care as
      that offered in BCH. Initial work will gather the views of staff delivering the hospital
      service and those of patients and parents to identify the crucial components of the
      intervention that are likely to be needed in primary care and to then to refine the
      intervention.A pilot trial will examine how feasible it is to recruit patients into the
      service and get some initial idea as to whether weight management is equally good, patient
      satisfaction and retention improves and what data needs to be collected for a full economic
      assessment. If found to be effective, the next step will be to use knowledge gained in this
      study to design and undertake a more extensive, formal study across Bristol in various
      primary care settings.This larger study will address how such a service can be delivered
      across a complete spectrum of primary care populations, so that similar services could be
      developed across the country.
    

Detailed description: 
      The care of childhood obesity clinic (COCO) at Bristol Royal Hospital for Children (BCH)
      provides a proven and effective treatment service for childhood obesity and is one of only a
      few specialist centres in the UK. The clinic service is based around a multidisciplanary team
      comprising: consultant; specialist nurses; dietitian: exercise specialist. This pilot study
      examines the feasibility of transferring the hospital clinic to a nurse led primary care
      setting in preparation for a full RCT. The study involves training a practice nurse to
      deliver the service in primary care alongside a dietitian and exercise specialist. Initial
      work will collect the views of staff delivering the hospital service and patients and parents
      which will enable us to identify the components of the service that will be needed to run a
      primary care based service. As a pilot we will focus on: (a) whether weight management is
      equally good in primary care; (b) whether recruitment, patient retention and satisfaction can
      be improved in primary care and (c) what data need to be collected for a full economic
      assessment.

      Children will be recruited to the trial by GP via electronic referral form designed by the
      study team. Families of children fulfilling recruitment criteria (age: 5-16, BMI≥98th
      centile) will be sent a study pack and reply form, all those who do not respond will be
      contacted by the COCO consultant to clarify willingness to participate. Families declining
      participation will follow usual care pathway. Recruited families will be randomised to one of
      two primary care clinics or COCO clinic.
    

Intervention name(s): Obesity management framework
Intervention type(s): Behavioral
Intervention description(s): Treatment in primary care will be compared to treatment in a secondary hospital setting. Treatment in both cases will be provided by a multi-disciplinary team of: obesity or practice nurse, dietitian, exercise specialist with some input from medical team.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Childhood; Obesity; Primary Care