Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial

Implementing routine paediatric height/length and weight screening and weight management advice by clinicians: an evaluation

OBJECTIVE

To determine the views of health care professionals (HCPs) in South Western Sydney Local Health District (SWSLHD) about the effectiveness of implementation strategies used to increase routine height/length and weight screening, advice, and referral for children and adolescents. A secondary aim was to explore the prevalence of weight bias among HCPs.

METHODS

A questionnaire was sent to all HCPs who had undertaken online or face-to-face training between December 2018 and June 2020 in SWSLHD (n=840). The questionnaire collected data on their experience of routine height and weight screening and the effectiveness of strategies used in the implementation. It also included a weight bias assessment. Data were provided by the New South Wales (NSW) Ministry of Health on the performance of routine height/length and weight measures entered into the electronic medical records (eMR) in SWSLHD.

RESULTS

Of the 840 questionnaires sent, 87 were undeliverable; of the remaining 753, 285 were returned (38% response rate). More than half (53%, 151/285) of the participants were nurses. Most HCPs agreed that there was a need for routine screening and reported that education, training, and access to resources were the most helpful implementation strategies. Most HCPs were confident in performing routine screening but were less confident in raising the issue of weight with children and their families. Barriers to implementation were lack of time, equipment, appropriate clinical setting, and HCPs' perceptions and beliefs about obesity.

CONCLUSION

Routine screening is the first step in identifying children and adolescents at risk of overweight and obesity, but many HCP found it challenging to incorporate into daily practice. Multifaceted strategies are effective in increasing routine screening across diverse healthcare settings so that children and adolescents receive timely and appropriate intervention.

Improving the Quality of Nursing Care for Late Preterm Infants

BACKGROUND

Late preterm infants in the Maternal Child Services Department at a Midwestern medical center were cared for in 3 separate nursing units. Standardization of care was a performance goal for the Department.

PURPOSE

A quality improvement process was implemented that included planning, teaching, performance application, and evaluation of evidence-based practice guidelines for care of the late preterm infant.

METHODS

A web-based teaching module was developed to introduce nursing care guidelines for late preterm infants to the nursing staff.

RESULTS

Analysis of the pre-and posttest scores embedded in the educational video showed a statistically significant increase in the nurses' knowledge about potential complications of infants born between 34 and 36 weeks' gestation.

IMPLICATIONS FOR PRACTICE

Quality improvement process increases nurses' knowledge about care of the late preterm infant and can lead to standardization of care.

IMPLICATIONS FOR RESEARCH

Ongoing quality improvement monitoring is needed for sustainability.

Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project

BACKGROUND

Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.

LOCAL PROBLEM

Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.

METHODS

This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.

INTERVENTIONS

Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a "Lunch and Learn" educational session at a Federally Qualified Health Care Center located in the Northern California.

RESULTS

The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.

CONCLUSIONS

Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.

Improvement in Primary Care Provider Self-Efficacy and Use of Patient-Centered Counseling To Address Child Overweight and Obesity after Practice-Based Changes: Texas Childhood Obesity Research Demonstration Study

BACKGROUND

The Texas Childhood Obesity Research Demonstration project, a multicenter, multisystem approach to childhood overweight and obesity (OW/OB), included training and materials to support primary care clinics (PCCs) in addressing child OW/OB in the office. This study evaluated the impact over 24 months of brief training and practice-based support on primary care providers' (PCPs) perceived self-efficacy and practice behaviors.

METHODS

The PCPs at five Houston and seven Austin PCCs completed questionnaires at baseline (2012, n = 36), 12 months (2013, n = 30), and 24 months (2014, n = 34) follow-up. Mixed-effects linear regression models were used to compare changes in self-efficacy (15 items, responses 1-4: not at all confident to very confident) and practice behaviors (30 items, responses 0-4: never to always) in obesity-related screening and counseling, and to assess association between prior training and these outcomes.

RESULTS

Self-efficacy items for identification of (2.9 [0.1] vs. 3.3 [0.1]) and counseling about (2.8 [0.1] vs. 3.4 [0.1]) OW/OB-related parenting practices, and setting behavioral goals (2.9 [0.2] vs. 3.3 [0.2]) improved significantly (p < 0.05) between baseline and 24-month follow-up. Self-efficacy items with "confident" mean baseline scores that further improved included determining child OW/OB (3.6 [0.1] vs. 3.9 [0.1]) and interpreting BMI (3.6 [0.1] vs. 3.9 [0.1]). At all measurements, PCPs reported frequently addressing medical problems and lifestyle behaviors. Use of patient-centered counseling techniques, which was low at baseline, increased significantly, including asking permission before discussing lifestyle (1.5 [0.3] vs. 2.4 [0.3]). Prior training was associated with improved self-efficacy.

CONCLUSIONS

The improvement in PCPs' self-efficacy and patient-centered counseling to address childhood OW/OB supports implementation of brief training and practice support in clinics that serve Medicaid-eligible children.

Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing

Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population.