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Chae K, German J, Kendrick K, Tackett S, O'Rourke P, Gudzune KA, Laudenslager M. An obesity medicine curriculum increases the obesity care self-efficacy of internal medicine residents in the primary care setting. Clin Obes 2024; 14:e12656. [PMID: 38551164 DOI: 10.1111/cob.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/13/2024]
Abstract
Primary care physicians (PCPs) report insufficient knowledge and training gaps in obesity care. Internal Medicine (IM) residency offers an opportunity to address this educational gap for future PCPs. We designed an innovative, multicomponent curriculum on obesity medicine (OM) in the primary care setting for IM residents. We then conducted a prospective, 6-month, two-arm study within two residency programs in Maryland evaluating feasibility (use, appropriateness for IM training, and satisfaction) of the curriculum as well as changes in self-efficacy within seven obesity care domains, assessed on 4-point scales (1-not at all confident to 4-very confident). One residency program received the curriculum and the other served as the control group. We recruited 35 IM residents to participate (17 intervention, 18 control). Among intervention residents, 42% used all curricular components; appropriateness and satisfaction with the curriculum were high. Compared with controls, intervention residents had statistically significant increases in five obesity care self-efficacy domains: nutrition (intervention 0.8 vs. control 0.2, p = .02), behaviour change (1.2 vs. 0.4, p < .01), weight-gain-promoting medications (0.8 vs. 0.1, p = .01), anti-obesity medications (1.2 vs. 0.5, p = .03), and bariatric surgical counselling (0.9 vs. 0.4, p = .03). There were no significant changes in physical activity or post-bariatric surgical care domains. Our OM curriculum is feasible with IM residents and increases residents' obesity care self-efficacy beyond what is achieved with usual IM training.
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Affiliation(s)
- Kacey Chae
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Karla Kendrick
- Winchester Hospital Weight Management Center, Beth Israel Lahey Health, Woburn, Massachusetts, USA
| | - Sean Tackett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul O'Rourke
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Marci Laudenslager
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hall LH, Thorneloe R, Rodriguez-Lopez R, Grice A, Thorat MA, Bradbury K, Kamble MW, Okoli GN, Powell D, Beeken RJ. Delivering brief physical activity interventions in primary care: a systematic review. Br J Gen Pract 2022; 72:e209-e216. [PMID: 34782318 PMCID: PMC8597771 DOI: 10.3399/bjgp.2021.0312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown. AIM To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity. DESIGN AND SETTING A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results. METHOD CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model. RESULTS After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice. CONCLUSION PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.
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Affiliation(s)
- Louise H Hall
- National Institute for Health Research (NIHR) in-practice fellow
| | - Rachael Thorneloe
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield
| | | | - Adam Grice
- National Institute for Health Research (NIHR) in-practice fellow
| | - Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Katherine Bradbury
- NIHR Southampton Biomedical Research Centre, NIHR Applied Research Collaboration Wessex, Southampton
| | | | - Grace N Okoli
- Institute of Population Health Sciences, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Daniel Powell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen
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McFadden T, Fortier M, McGinn R, Levac BM, Sweet SN, Tomasone JR. Demographic differences in Canadian medical students' motivation and confidence to promote physical activity. Fam Pract 2020; 37:56-62. [PMID: 31271643 DOI: 10.1093/fampra/cmz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity (PA) remains under prescribed by physicians. Motivation and confidence are clear drivers of frequency of promoting PA. Research shows demographic differences in physicians' preventive practices, yet none have included medical students who form habits during training. OBJECTIVES Study objectives were to (i) examine how Canadian medical students' motivation to recommend PA to future patients differs according to six demographic variables (i.e. gender, ethnicity, year of study, university, proposed specialty and academic background) and (ii) examine how Canadian medical students' confidence to recommend PA to future patients differs according to these same demographic variables. METHODS A cross-sectional design was used. First to fourth year medical students from three medical schools responded to an online survey (N = 221). RESULTS Female participants were more motivated to counsel patients on PA and refer to an exercise specialist compared to males (P < 0.01). Second year students were more motivated to assess a patients' level of PA compared to third and fourth year students (P < 0.01). Students pursuing family medicine were more confident to assess and counsel compared to students pursuing paediatrics (P < 0.01). CONCLUSION Given that motivation and confidence have a positive influence on frequency-promoting PA, these results suggest where future efforts should focus, to improve PA promotion in medical practice. Physical inactivity continues to be a major issue worldwide, and medical students as future physicians have a unique opportunity to enhance PA amongst the population.
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Affiliation(s)
- Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa.,Physician Health and Wellness, Canadian Medical Association, Ottawa
| | | | - Ryan McGinn
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa.,Faculty of Medicine, University of Ottawa, Ottawa
| | - Brendan M Levac
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
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Banks A, Samuel S, Johnson D, Hecker K, McLaughlin K. Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection: evaluation of a purposefully sequenced educational intervention. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e6-e14. [PMID: 30498539 PMCID: PMC6260512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children. METHODS Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model. RESULTS One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]). CONCLUSION Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.
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Affiliation(s)
- Anke Banks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - David Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kent Hecker
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Moscetti CW, Pronk NP. Invisible seams: Preventing childhood obesity through an improved obstetrics-pediatrics care continuum. Prev Med Rep 2017; 5:1-3. [PMID: 27872800 PMCID: PMC5109285 DOI: 10.1016/j.pmedr.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022] Open
Abstract
Progress in altering the current obesity epidemic among children and adolescents remains elusive. Evidence continues to underscore the challenges of altering weight status as children age. Further, weight loss interventions among children and adults alike tend to demonstrate efficacy in the short-term, however individuals tend to slowly revert back to their original weight status over time. New understanding of obesity's early origins suggests the need to rethink current approaches, particularly within healthcare. Instead of a predominant focus on "mid-flight course corrections," healthcare should consider the "take-off" time period for health trajectories. This means improved support and promotion of healthy behaviors before and after birth, and with both the mother and infant. To meet the challenge, greater continuity will be required across obstetrics and pediatrics, which often operate independently, focused on different clinical outcomes. Likewise, there is an urgent need to remedy a significant skills gap within both practices. Through its connection with almost every new mother, healthcare plays a unique and vital role in maternal and child health outcomes. A more seamless obstetrics-pediatrics care continuum could better address the early origins of obesity, factors that we are coming to learn have life-long consequences.
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Affiliation(s)
- Craig W. Moscetti
- Allina Health, 7590 Lyric Lane, Fridley, MN 55432, USA
- HealthPartners, 8170 33 Ave S, Bloomington, MN 55425, USA
| | - Nicolaas P. Pronk
- HealthPartners, 8170 33 Ave S, Bloomington, MN 55425, USA
- HealthPartners Institute for Education and Research, 8170 33 Ave S, Bloomington, MN 55425, USA
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Forjuoh SN, Lee C, Won J, Towne SD, Wang S, Ory MG. Correlates of Receiving a Recommendation for More Physical Activity From a Primary Care Provider. Am J Prev Med 2017; 52:207-214. [PMID: 27890517 DOI: 10.1016/j.amepre.2016.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/12/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Primary care providers (PCPs) are strategically positioned to communicate with their overweight/obese patients about positive behavioral changes to improve health and functioning. Demographic and behavioral correlates of receiving a recommendation for more physical activity (PA) from a PCP by overweight/obese patients were assessed. METHODS Community-dwelling adults aged ≥50 years from four Texas cities who were seen by a family physician in a primary care clinic were surveyed from October 2013 to June 2014. Multivariate logistic regression predicted the likelihood of receiving a PA recommendation from a PCP, controlling for sociodemographic factors, health conditions, and walking behaviors. The analysis was conducted in 2016. RESULTS Of the total 388 participants (survey response rate, 6.8%), 30.1% were obese, 55.4% were female, and most were non-Hispanic white (82.9%), married (75.6%), or reported an annual household income of ≥$50,000 (66.8%). Receipt of a PA recommendation from a PCP (n=151, 38.9%) was significantly correlated with reporting poor to fair health (OR=7.33, 95% CI=2.6, 20.32), obesity (OR=2.95, 95% CI=1.69, 5.14), having only a little or some difficulty walking for a quarter of a mile (OR=2.94, 95% CI=1.41, 5.88), not walking the recommended ≥150 minutes for any purpose (OR=2.60, 95% CI=1.25, 5.38), and being employed (OR=2.11, 95% CI=1.13. 3.94). CONCLUSIONS PCPs seem to be targeting obese, inactive individuals with poor to fair health, populations traditionally not encouraged to be more physically active. These findings are consistent with the current trend in medical care to recommend positive lifestyle changes to a broader range of the population.
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Affiliation(s)
- Samuel N Forjuoh
- Department of Family and Community Medicine, Baylor Scott and White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas; Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas.
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
| | - Jaewoong Won
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas
| | - Suojin Wang
- Department of Statistics, College of Science, Texas A&M University, College Station, Texas
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas
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Vesely JM, Pronk NP, Kottke TE, Marshall PS. Obesity Treatment at HealthPartners: Adaptation of Clinical Guidelines into Systems for Practice Operations. Curr Obes Rep 2016; 5:312-9. [PMID: 27342444 DOI: 10.1007/s13679-016-0220-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this paper is to describe how HealthPartners health system in Minneapolis, MN, has translated a clinical guideline for obesity among adults into an efficient care delivery practice operations system. Based on a foundation provided by the physician-led Institute of Clinical Systems Improvement (ICSI)-developed Prevention and Management of Obesity for Adults Health Care Guideline, HealthPartners adapted the guideline into an electronic health record-based "Smart Set" that provides frontline physicians with the information, treatment options, and referral steps necessary to care for their patients with obesity. Additional context is provided in terms of insurance coverage and systems-based resources designed to prevent and treat obesity for adults.
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Affiliation(s)
- Jennifer M Vesely
- Obesity Medicine and Medical Weight Management, Park Nicollet Health Services, HealthPartners, 8240 Golden Valley Drive, Golden Valley, Minneapolis, MN, USA
| | - Nicolaas P Pronk
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA.
| | - Thomas E Kottke
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA
| | - Peter S Marshall
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA
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Lobelo F, de Quevedo IG. The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models. Am J Lifestyle Med 2016; 10:36-52. [PMID: 26213523 PMCID: PMC4511730 DOI: 10.1177/1559827613520120] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 11/15/2022] Open
Abstract
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
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Affiliation(s)
- Felipe Lobelo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabel Garcia de Quevedo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Steeves JA, Liu B, Willis G, Lee R, Smith AW. Physicians’ personal beliefs about weight-related care and their associations with care delivery: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians. Obes Res Clin Pract 2015; 9:243-55. [DOI: 10.1016/j.orcp.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/22/2014] [Accepted: 08/01/2014] [Indexed: 01/30/2023]
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Klabunde CN, Clauser SB, Liu B, Pronk NP, Ballard-Barbash R, Huang TTK, Smith AW. Organization of Primary Care Practice for Providing Energy Balance Care. Am J Health Promot 2014; 28:e67-80. [DOI: 10.4278/ajhp.121219-quan-626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Primary care physicians (PCPs) may not adequately counsel or monitor patients regarding diet, physical activity, and weight control (i.e., provide energy balance care). We assessed the organization of PCPs' practices for providing this care. Design. The study design was a nationally representative survey conducted in 2008. Setting. The study setting was U.S. primary care practices. Subjects. A total of 1740 PCPs completed two sequential questionnaires (response rate, 55.5%). Measures. The study measured PCPs' reports of practice resources, and the frequency of body mass index assessment, counseling, referral for further evaluation/management, and monitoring of patients for energy balance care. Analysis. Descriptive statistics and logistic regression modeling were used. Results. More than 80% of PCPs reported having information resources on diet, physical activity, or weight control available in waiting/exam rooms, but fewer billed (45%), used reminder systems (< 30%), or received incentive payments (3%) for energy balance care. A total of 26% reported regularly assessing body mass index and always/often providing counseling as well as tracking patients for progress related to energy balance. In multivariate analyses, PCPs in practices with full electronic health records or those that bill for energy balance care provided this care more often and more comprehensively. There were strong specialty differences, with pediatricians more likely (odds ratio, 1.78; 95% confidence interval, 1.26–2.51) and obstetrician/gynecologists less likely (odds ratio, 0.28; 95% confidence interval, 0.17–0.44) than others to provide energy balance care. Conclusion. PCPs' practices are not well organized for providing energy balance care. Further research is needed to understand PCP care-related specialty differences.
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