Canadian Family Physician最新文献

Objective: To identify patients who may or may not benefit from use of new drugs for weight loss and to aid in minimizing loss of lean mass through proactive nutrition and exercise interventions.

Quality of evidence: Choices and interventions are evaluated using the Grading of Recommendations Assessment, Development and Evaluation framework. Quality varies widely and is documented in multiple tables.

Main message: Semaglutide and tirzepatide should be used in patients living with obesity or with overweight accompanied by weight-related comorbidity. Long-term use may be necessary. Use in children and adolescents has proven effective for weight reduction, but long-term consequences are unknown. Use in elderly patients may be harmful. Because weight loss by any means is accompanied by loss of lean mass, specifically muscle and bone, particular attention must be paid to nutrition and exercise. Protein supplementation is effective to preserve muscle mass. Resistance training is effective in mitigation of both muscle and bone loss. Both resistance and aerobic training are beneficial in preventing osteopenia in weight loss, which may contribute to premature mortality. There is observational evidence that weight cycling may be harmful in that weight regain can be composed primarily of fat, multiple cycles of which may actually increase obesity in individuals. This is of particular concern because of the cost and limited availability of new weight loss drugs leading to large rates of discontinuation. Similarly, patients using drugs for small amounts of weight loss are likely to regain or overshoot if they discontinue.

Conclusion: Patient selection for use of new anti-obesity drugs should match those included in clinical trials and be paired with dietary and exercise interventions used in those trials. Use at the extremes of age is problematic because of lack of long-term data. Intermittent use for small amounts of weight loss may be harmful. More ongoing data are needed.

Objective: To understand the health care-seeking behaviour and preferences of people in Canada who report not having a primary care clinician (PCC; family doctor or nurse practitioner).

Design: An anonymous, online, national cross-sectional survey was conducted. It was available from September 2022 to October 2022 in English and French. Responses were weighted based on sociodemographic factors to approximate the population of Canada.

Setting: Canada.

Participants: People aged 18 years or older.

Main outcome measures: Characteristics, health care-seeking behaviour, and preferences of people without a primary care clinician compared to people with one.

Results: A total of 9279 completed surveys were analyzed. About 21.8% of respondents said they did not have a primary care clinician. Among these, 83.1% said they were trying to find one and 66.2% of those looking reported doing so for over 1 year. Fewer men (vs women) (78.0% vs 89.3%; P<.001) and people without supplementary health benefits (vs with) (72.1% vs 85.8%; P<.001) reported looking. More people without a primary care clinician (vs with) indicated they tried getting care from a walk-in clinic (71.8% vs 41.2%; P<.001), but fewer reported their needs being met (40.6% vs 55.3%; P<.001). More people without a primary care clinician responded favourably to potential team- and neighbourhood-based care reforms.

Conclusion: People without a regular family doctor or nurse practitioner face several challenges. Many are trying to find one, but cannot. They value relationship-based care yet are more likely to use walk-in clinics and less likely to be satisfied with that care compared to people with a primary care clinician. Reforms should align with the values and preferences of those without primary care.