Commissioner, clinician, and patient experiences of a pre‐surgical health optimisation programme: a qualitative study

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Health optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. There is little evidence about their impact and the experience of their use. The aim of this study was to investigate the experiences and perspectives of commissioners, clinicians and patients involved in a locality’s health optimisation programme in the United Kingdom. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral.

A thematic analysis of semi-structured interviews (n = 20) with National Health Service and Local Authority commissioners and planners, healthcare professionals, and patients using the pathway.

Health optimisation was broadly acceptable to professionals and patients in our sample and offered a chance to trigger both short term pre-surgical weight loss/smoking cessation and longer-term sustained changes to lifestyle intentions post-surgery. Communicating the nature and purpose of the programme to patients was challenging and consequently the quality of the explanation received and understanding gained by patients was generally low. Insight into the successful implementation of health optimisation for the hip and knee pathway, but failure in roll-out to other surgical specialities, suggests placement of health optimisation interventions into the ‘usual waiting time’ for surgical referral may be of greatest acceptability to professionals and patients.

Patients and professionals supported the continuation of health optimisation in this context and recognised likely health and wellbeing benefits for a majority of patients. However, the clinicians’ communication to patients about health optimisation needs to improve to prepare patients and optimise their engagement.
Original languageEnglish
Article number409
Pages (from-to)409
Number of pages10
JournalBMC Health Services Research
Issue number1
Early online date1 May 2021
Publication statusPublished - 1 May 2021

Bibliographical note

Funding Information:
This research was funded and sponsored by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), with which several of the authors are affiliated, JM is funded by a NIHR Academic Clinical Fellowship, LO and RR’s time was funded by Bath and North East Somerset Clinical Commissioning Group and Council respectively.

Publisher Copyright:
© 2021, The Author(s).

Structured keywords

  • NIHR ARC West


  • Health optimisation
  • Prehabilitation
  • Elective surgery
  • Behavioural change
  • Obesity
  • Smoking


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