Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

OBJECTIVE To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). DESIGN Cross-sectional study. SETTING Regional specialist WMS located in the West of Scotland. PARTICIPANTS 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. ANALYSIS Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. RESULTS Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18-24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30-35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. CONCLUSIONS There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation.