Not enough, again

In this issue of BMJ USA, Moore et al (p 35) report a practice-based randomized trial that assessed a 4.5 hour training program delivered by dietitians to general practitioners and practice staff to improve their knowledge and management of obesity in adults. The primary outcome was patients' weight change at 12 months, and secondary outcomes included practitioners' knowledge and process measures. While knowledge improved and intervention practices appear to have “tried harder,” there was no weight loss in patients. The authors reported that the intervention strategy was only partially implemented in study practices. Combining this partial implementation with the known limited effects of increased knowledge alone on changing practice, the study's findings are exactly the results one would expect.

This intervention focused on clinician knowledge rather than how frontline practice happens. It further supports the view that interventions loaded into primary care practices without consideration of competing demands1 and practice redesign will likely continue to fail until a new model of primary care practice emerges.

As in …