Oral Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

Evaluating the implementation of an embedded service for obesity in a sleep disorders clinic at a tertiary hospital setting using the RE-AIM framework (#13)

Elizabeth A Machan 1 2 , Claudia Harper 1 , Gislaine Gauthier 3 , Bandana Saini 1 2 , Brendon Yee 1 2 3
  1. CIRUS Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie Park, NSW, Australia
  2. Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
  3. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Introduction: Obstructive sleep apnea (OSA) affects over 3.5 million Australians and is a common health complication in people living with obesity. We previously developed a weight management Program focused on Sleep, Lifestyle, Energy, Eating and Exercise (SLEEEP)1. We used the RE-AIM framework to evaluate routine implementation of SLEEEP in a hospital Sleep Disorders Unit (SDU).

Methods: A hybrid type-2 implementation study with co-primary aims to determine SLEEEP effectiveness and implementation feasibility. All patients aged 18-65 with OSA and obesity attending Royal Prince Alfred Hospital SDU, NSW were considered for participation, (HREC/18/RPAH/727).

A study dietitian supervised patients in a very low energy diet (VLED), followed by a 3–9-month maintenance program. Mixed methods included pre/post-implementation stakeholder meetings, surveys, interviews and administrative data exploring barriers, facilitators and service perception,.

Results:

Reach: retrospective electronic medical record audit between 2017-2019 (n=2067) indicated 77% of people attending the SDU were overweight/obese and 49% had moderate-severe OSA. Despite 33% being eligible for Metabolism and Obesity Services, 4% were referred. SLEEEP recruited 50 patients, 36 completed the VLED phase and 34 completed 6-month follow up.

Effectiveness: Patients experienced enhanced weight loss outcomes. Six month weight loss was 14.8±10.1 kg (14%,n=34) and OSA reduced by 34% (n=14).

Adoption: Exit surveys and focus groups indicated positive uptake and constructive review. Clinicians sustained engagement and supported service retention for improved clinical outcomes.

Implementation: Of the 664 patients considered, 163 (24.5%) were referred in a cumulative period of 10 months. Barriers included consultation space and COVID-19 shutdown related telehealth adaptation and recruitment cessation.

Maintenance: The program established clear pathways for future referral to obesity services beyond the embedded program. Evaluating long-term uptake and health indicators was challenging due to a lack of departmental champion.

Conclusions: The positive uptake, effectiveness and streamlining of SLEEEP provide adequate basis for intervention upscaling.

  1. 1. Cayanan, E. A., Marshall, N. S., Hoyos, C. M., Phillips, C. L., Serinel, Y., Wong, K. K. H., Yee, B. J., & Grunstein, R. R. (2018). Maintenance diets following rapid weight loss in obstructive sleep apnea: a pilot 1-year clinical trial. Journal of sleep research, 27(2), 244–251. https://doi.org/10.1111/jsr.12572