Giving "prescriptions" for paediatric weight management follow-up in primary care

STEP IN: Supporting Together Exercise and Play and Improving Nutrition; a Feasibility Study of Parent-Led Group Sessions and Fitness Trackers to Improve Family Healthy Lifestyle Behaviors in a Low-Income, Predominantly Black Population

BACKGROUND

Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed.

METHODS

This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent-child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking.

RESULTS

27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot (100%, 0 dropouts), high in the full six-session biweekly cohort (83%, 1 dropout), and moderate in the monthly cohort (62.7%, 4 dropouts). Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families.

CONCLUSION

Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes.

A Quality Improvement Initiative Addressing Provider Prescription of Weight Management Follow-up in Primary Care

Introduction

Few providers routinely comply with the American Academy of Pediatrics recommendations to prescribe weight management follow-up in-between well-child checks for children with obesity/overweight. This quality improvement (QI) project aimed to increase the percentage of patients prescribed weight management follow-up within three months of their well-child check.

Methods

The project took place in 1 outpatient primary care clinic at a large, free-standing children's hospital from May 2018 to April 2019. We grouped interventions in 4 Plan-Do-Study-Act ramps with the following themes: (1) provider education; (2) electronic health record note changes; (3) discharge order modifications; and (4) provider feedback. The primary outcome was the percent of patients ages 2-18 years with body mass index ≥ 85% that had an order placed to schedule a follow-up weight management appointment in primary care. We monitored attendance rates for scheduled follow-up visits as a balancing measure.

Results

Mean prescription rates increased from 32% at baseline to 58%, with special cause analysis demonstrating improvement. Of patients prescribed follow-up, 40% returned for a weight management visit, compared to 13% before the QI initiative. The no-show rate was 35%.

Conclusions

The utilization of QI methodology led to an increase in the percentage of patients appropriately prescribed weight management follow-up and a resultant increase in the number of patients seen for follow-up. The next steps include a re-examination of process failures to improve patient buy-in in follow-up prescriptions.