Patient weight counseling choices and outcomes following a primary care and community collaborative intervention

https://doi.org/10.1016/j.pec.2010.01.025Get rights and content

Abstract

Objective

Obesity has become a public health epidemic in adults and children. Clinician practices need new models to effectively address overweight in patients, yet, practices lack time and resources. We tested a clinician-delivered intervention that utilized community resources for in-depth counseling for unhealthy behaviors including overweight.

Methods

Eligible patients in nine primary care practices were identified using an electronic linkage system (eLinkS) which also automated patient referrals to group (Weight Watcher's), telephone counseling (TC), or usual care. Pre/post-survey data were used to assess factors related to counseling choices as well as changes in BMI (kg/m2) and weight-related behaviors using descriptive statistics, unadjusted, and adjusted statistical analyses.

Results

Study sample (n = 146) was 70% female with a mean age of 57 years. More patients (57%) selected WW, followed by usual care (27%) or TC (16%). Age, gender, clinician recommendation, and counseling program characteristics were influential in counseling selections. Weight Watcher's participants and those in TC, reported statistically significant weight loss, WW participants also reported significant increases in fruit/vegetable intake; after 4 months compared with usual care.

Conclusions

This practice-based intervention utilizing community counseling referrals was associated with positive health behavior change.

Practice Implications

Identifying influential factors related to patient weight counseling choices may help guide referrals to community programs.

Introduction

More Americans than ever before are overweight or obese, creating a daunting public health issue that cuts across age, gender, and ethnic domains in our society. Currently, 33% of adults are overweight and 34% are obese; data that represent the significant increases in overweight prevalence rates from 1988 to 2004 [1], [2]. As such, this national epidemic requires immediate action and novel solutions to slow the current trajectory. Reducing obesity will require new perspectives and significant changes in the way the problem is addressed by physicians, researchers, parents, public health institutions, and community groups. Clinicians and practices, as systems of care, face a growing need to offer patients high-quality resources on health behavior change and health promotion strategies; yet, medical practices may lack the time and resources to thoroughly assess the health behaviors of patients, their readiness to change, or the type of assistance they need [3], [4].

Having been encouraged by clinicians to improve health habits, patients often seek additional resources regarding techniques, motivational strategies, and community programs. However, studies show that only 65% of obese patients receive the advice they seek on weight loss [5]. Physician organizations and practice groups are proactively developing and testing new approaches for addressing overweight and obesity in patients who need more structure, motivation, and resources [6].

The use of the electronic medical record (EMR) provides clinicians with technology to easily identify patients with unhealthy behaviors, a counseling platform such as the 5 A's (Assess, Advise, Agree, Assist, Arrange) [10], and the ability to automate referrals to outside health behavior counseling services [7], [8]. EMRs can be programmed to identify patients who smoke or are overweight and prompt clinicians to initiate counseling about improving health behaviors. Such features can be valuable for identifying groups of patients who would benefit from more intensive counseling through referral to community resources [9]. More research is needed to assess and evaluate the features of low-intensity interventions that most practices could potentially deliver.

Section snippets

eLinkS intervention

This study was part of the Prescription for Health initiative, sponsored by the Robert Wood Johnson Foundation, to study new approaches of addressing unhealthy lifestyle behaviors in primary care practices [12]. Details of the study intervention are reported elsewhere [11]. Briefly, this study tested a clinician-delivered (clinicians included physicians, physician assistants, and nurse practitioners) intervention (eLinkS) that utilized an EMR-based prompt and referral system to identify adult

Demographic characteristics and selection of weight counseling programs

Demographic characteristics are shown for the study sample and by group in Table 1. The mean age of the participants was 57 years old and 70% of the sample was female. The sample included minorities (28%), low-income patients (36%), and a large representation of persons with no college education (41%).

Of the three weight loss counseling options, group classes (WW) were the most popular counseling choice (n = 83), followed by usual care (n = 39) and telephone counseling (n = 24). The counseling groups

Discussion

Research documents the need for testing new clinician-based interventions to help patients improve health behaviors [17], [18], [19], [20], [21]. In this study, patients referred to weight loss counseling overwhelmingly preferred group classes (WW) to telephone counseling and usual care. This preference was so substantial that intervention intake reached maximum capacity after only 5 weeks. Some features of the counseling programs and characteristics of our sample may have contributed to this

Acknowledgements

The authors thank the practices in Riverside Medical Group that participated in this study: Bruton Avenue Family Medicine, Eagle Harbor Primary Care, Elizabeth Lakes Family Practice, Hilton Family Practice, Mathews Medical Center, Mercury West Medical Center, Patriot Primary Care, Riverside Family Medicine, and Williamsburg Medical Arts Family Practice. We also thank the staff of Weight Watchers™ International, Riverside Wellness Center, and the University of Kentucky Health &Wellness Behavior

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