1194 / Programme for secondary prevention of adult obesity

“Best fit” category of the reported practice
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
Improve the care protocol of the treatment of adult obesity in primary care, to reduce differences in the use of health resources, variability in the results and the quality of patient care.
Description of the Patient Safety Practice
The “Program for secondary prevention of adult obesity in the Aragon Health Service” is a non-pharmacological dietetic-therapeutic project based on diet, physical activity and education for obese adults.
Once patients were selected, following the inclusion and exclusion criteria (María Teresa Bimbela et al, 2014), and after preparing its history, each person was developed a low-calorie diet for weight loss by a predetermined system (Closed diet) or by a system not preset (diet exchanges). Upon reaching the proper weight, each patient a normocaloric weight maintenance diet was performed by default (Closed diet) or non-routine diet (diet exchanges). Therapeutic diets were customized to improve patient adherence and prevent the occurrence of problems by inadequate recommendations to the person to start treatment. Thus, from the daily caloric needs of each patient calculated by total energy expenditure (TEE) a caloric reduction estimated total of 400-500 Kcal was performed to achieve a rate of weight loss of approximately 0.5 to 1 Kg / week approx. or 1% by weight. Patients and / or their relatives responsible for preparing daily menus, home used reference measurements given by the healthcare professional. Furthermore, it took into account the planning of weekly physical activity (recommendation 60 to 90 minutes walking / day). IMPLEMENTATION 1ST PHASE: Through computerized medical record (IMO), the selection of the sample was conducted by telephone and contacted these patients (María Teresa Bimbela et al, 2014) . PHASE 2: Realization, each patient, the following actions at the beginning and end of treatment: – Eating habits (Consumption Frequency Questionnaire) and weekly physical activity – Perception of quality of life through the questionnaire “SF-36 Spanish Version” – Testing Laboratory (biochemistry, blood count, thyroid hormones and urine analysis) – Calculation of cardiovascular risk (CVR) and calculating individualized diet prescribed depending on the basal metabolism and energy expenditure (eg Harris Benedict) 3RD STAGE: individualized treatment was developed, according to the caloric needs for each patient calculated. 4TH PHASE: weight, height, waist-hip circumference, arm circumference, body folds and / or bioelectrical impedance: checks every two or three weeks where food difficulties were studied and anthropometric patient data were conducted were determined. The duration of dietary treatment of obesity was different in each case, although a maximum of 48 weeks was set to lose 10% of body weight and 48 weeks for weight maintenance as well as nutrition education sessions, taking into note that you need to follow to boost their motivation and adherence and may have weight gain without dietary transgressions in case of drug-induced water retention, premenstrual … 5TH STAGE: When you start the weight maintenance phase the following topics were addressed through individual educational sessions (15-30 min for each query): Balanced diet “Food pyramid”; Distribution of food groups throughout the day and week, Diet for exchanges and interchangeable portions… 6TH STAGE: After completing the full dietary treatment, each patient was proposed freely go every 6 months during the first year with their self-administered records (collected by the patient) to the nursing and annually thereafter to medicine consultation with their records to request blood tests and urine; as well as record of the evolution of treatment. RATING Before starting the statistical analysis in relation to objectives, screening of information obtained in the database (Excel), with the intention of identifying erroneous observations it was made. Then the descriptive analysis of the sample was drawn. In the case of numerical variables they were summarized data in means and standard deviations, with confidence intervals unless distributions were asymmetric, in which case they used medians and quartiles. Statistical analysis was performed using the SPSS statistical software package. 15.0 for Windows. INDICATORS: 1. KNOW THE ADHERENCE BY THE PROGRAM DEVELOPED. A confidence level of 95% (significance level ? = 0.05) was established and a descriptive analysis of the sociodemographic data was performed by calculating the mean and standard deviation. 2. KNOW THE EVOLUTION OF EATING HABITS. A confidence level of 95% (? = 0.05) was established. For the study of eating habits normality test was performed at the nominal variables with Pearson Chi2 statistical treatment of the global survey McNemar contingency tables was performed. To survey the frequency of consumption Shapiro-Wilk test was used for normality tests and a study of related samples tests to check the variation in average global consumption before and after the nutritional sessions. 3. ASSESS THE LEVEL OF KNOWLEDGE OF PATIENTS EATING IN ADULTHOOD, AS A TOOL FOR HEALTH PROMOTION WITH THE SURROUNDING ENVIRONMENT. Education sessions where the initial and final knowledge of each of the topics covered by two Nestlé assessment test were evaluated. Through the use of the Food Guide Pyramid, they were organized and addressed the major food groups and nutrients, checking, before and after 3 sessions of 15-30 minutes on the distribution of the Pyramid, patient knowledge. Learning outcomes through value most often in data distribution (fashion) at each level of this figure were compared after completing the treatment period. 4. EVALUATE THE LEVEL OF ACCEPTANCE OF THE EDUCATIONAL PROGRAM. The Student t-test for independent samples was used to compare the quantitative data drawn between groups. For relational quantitative study between two dichotomous variables (measurement before / after measuring) the McNemar test was used and the possible change detected it was determined with a confidence interval of 95%. The level of statistical significance was set at p <0.05. 5. EVALUATE THE LEVEL OF USER SATISFACTION OF THE PILOT PROJECT AND THE BASIC HEALTH ZONE The results of the questionnaire were compared with the data shown in the “Survey of satisfaction of users of the Aragon Health System (ESU). Primary Care: Performance Report 2013 “, to assess the possible correlation of results. 6. EVALUATE THE PERCEPTION OF QUALITY OF LIFE. The test “Medical Outcomes Study Short Form 36” version 2.0 Spanish (SF-36 Health Survey) was used for evaluation of the quality of life of these patients. Pre- and post-study results were compared analyzing the nonparametric tests using the nonparametric paired sample Wilcoxon globally Test SF-36, the results of the mean scores of the 9 scales of the test and global categories of physical function and mental component.
Attachment of relevant written information and/or photos, as appropriate
Effectiveness of the Patient Safety Practice
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Team level
Specific and measurable outcome for the reported practice were defined
A baseline measurement before implementation of the reported practice was obtained
A measurement after full implementation of the reported practice was obtained
Evaluation of a “positive” effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation’s results
Comparative Study Of Three Factors That Determine Human Learning In Two Different Stages Of Change Co-authored by María Teresa Bimbela, Dr. Fernando Bimbela, Dr. Luis Bernués Published in International journal of Nursing Didactics (online) ISSN No. 2231-5454, Volume 4, December, Issue 7, 2014 Page No. 06 – 10. DOI:
Health care context where the Patient Safety Practices was implemented
Community care facility
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation’s level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
Dieticians/ Nutritionists
Quality manager
Patient Involvement
Direct service user’s involvement as integral part of this Patient Safety Practice
Specification of the service users or their representatives’ involvement in the implementation of this Patient Safety Practice
Point of time in which service user or their reprasentatives’ involvement takes place
During the implementation of the Patient Safety Practices
During the application of the Patient Safety Practice
Active seeking of service users’ opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Short description of the service users’ level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
List of sources where public information is accessible
Implementation of the Patient Safety Practice
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Involvement of service users
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Costs of the Patient Safety Practices
Completion of cost calculation related to this Patient Safety Practice
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here