The Impact of Primary Care Resident Physician Training on Patient Weight Loss at 12 Months

AbstractObjective:We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study.Design:A literature search of the impact of dietary counselling on BMI was performed to source the ‘best’ effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate.Setting:New Zealand (NZ).Participants:We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million).Results:Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval −70, 560 QALY) over the population’s lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Māori (Indigenous population) than for non-Māori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %.Conclusions:The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.

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Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight

American Journal of Health Promotion ◽

10.1177/0890117117690853 ◽

2017 ◽

Vol 32 (2) ◽

pp. 374-380 ◽

Cited By ~ 3

Author(s):

Elaine Seaton Banerjee ◽

Sharon J. Herring ◽

Katelyn E. Hurley ◽

Katherine Puskarz ◽

Kyle Yebernetsky ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

African American ◽

Mixed Methods ◽

African American Women ◽

Low Income ◽

Positive Deviance ◽

American Women ◽

Patient Reported ◽

The Impact

Purpose: Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs). Design: Mixed methods, positive deviance study. Setting: Urban university-based family medicine practice. Participants: The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months. Measures: The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews. Analysis: Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory. Results: The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary. Conclusion: The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss.

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PATHWEIGH, pragmatic weight management in adult patients in primary care in Colorado, USA: study protocol for a stepped wedge cluster randomized trial

Trials ◽

10.1186/s13063-021-05954-7 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Krithika Suresh ◽

Jodi Summers Holtrop ◽

L. Miriam Dickinson ◽

Emileigh Willems ◽

Peter C. Smith ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Randomized Trial ◽

Weight Management ◽

Implementation Strategies ◽

Cluster Randomized Trial ◽

Weight Loss Maintenance ◽

Stepped Wedge ◽

Patient Weight ◽

Cluster Randomized

Abstract Background Despite the overwhelming prevalence and health implications of obesity, it is rarely adequately addressed in a health care setting. PATHWEIGH is a pragmatic approach to weight management that uses tools built into the electronic medical record to overcome barriers and guide care. Implementation strategies are employed to facilitate adoption and use of the PATHWEIGH tools and processes. The current study will compare the effectiveness of PATHWEIGH versus standard of care (SOC) on patient weight loss in primary care and explore factors for its successful implementation. Methods A stepped wedge cluster randomized trial design will be used within an effectiveness-implementation hybrid study. Adult patient weight loss and weight loss maintenance will be compared in PATHWEIGH versus SOC in 57 family and internal medicine clinics in a large health system in Colorado, USA. Effectiveness will be evaluated using generalized linear mixed models to determine statistical differences in weight loss and weight loss maintenance at 6, 12, and 18 months. Patient-, provider-, and clinic-level predictors will be identified using mediator and moderator analyses. Conceptually guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), a mixed methods approach including quantitative (practice surveys, use tracking) and qualitative (interviews, observations) data collection will be used to determine factors impeding and facilitating adoption, implementation, and maintenance of PATHWEIGH and evaluate specified implementation strategies. A cost analysis of the practice and system costs and resources required by PATHWEIGH relative to the reimbursement collected will be performed. Discussion The effectiveness and implementation of PATHWEIGH, and their interrelatedness, for patient weight loss are collectively the focus of the current trial. Findings from this study are expected to serve as a blueprint for available and effective weight management in primary care medical practice. Trial registration ClinicalTrials.govNCT04678752. Registered on December 21, 2020.

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The Influence of Patient Age on Primary Care Resident Physician-Patient Interaction

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2000.tb03025.x ◽

2000 ◽

Vol 48 (1) ◽

pp. 30-35 ◽

Cited By ~ 31

Author(s):

Edward J. Callahan ◽

Klea D. Bertakis ◽

Rahman Azari ◽

John A. Robbins ◽

L. Jay Helms ◽

...

Keyword(s):

Primary Care ◽

Resident Physician ◽

Patient Age ◽

Patient Interaction ◽

Patient Âgé ◽

Primary Care Resident ◽

Physician Patient

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The Impact of a Clinical Pharmacist in an Interdisciplinary Weight Loss Service: A Follow-Up Study

INNOVATIONS in pharmacy ◽

10.24926/iip.v12i4.4356 ◽

2021 ◽

Vol 12 (4) ◽

pp. 13

Author(s):

Beverly R. Francis ◽

Laura Challen

Keyword(s):

Primary Care ◽

Weight Loss ◽

Clinical Pharmacist ◽

Standard Care ◽

Intervention Group ◽

Care Physician ◽

Care Group ◽

Percent Weight Loss ◽

Number Of Patients ◽

The Impact

Background: At an Internal Medicine outpatient clinic, patients are referred to a weight loss service by their primary care physician to be managed by a clinical pharmacist and dietician. Objective: A study was conducted to determine the impact of this established, interdisciplinary, pharmacist-driven weight loss service on percent weight loss from baseline in patients who are obese or overweight compared to those receiving standard weight loss care. Methods: This was a retrospective, single-center, cohort study including adults ≥18 years of age with BMI ≥30 or BMI ≥27 with at least one weight-related comorbidity such as hypertension, dyslipidemia, or type 2 diabetes mellitus, and referred to the clinic’s weight loss service or managed by their primary care physician. The primary outcome was percent weight loss from baseline. Key secondary outcomes included number of patients who had >5% weight loss in 6 months, number of patients who received liraglutide after 6 months, and percent weight loss in patients prescribed liraglutide. Statistical analysis included descriptive statistics, t-test for continuous outcomes, and chi-square test for between-group differences. Results: A total of 86 patients met inclusion criteria with 43 patients in the weight loss service group (intervention) and 43 patients in the primary care group (standard care). The intervention group had a significantly higher baseline weight and BMI than the standard care group (120.44 kg vs. 95.72 kg, p <0.001 and 45.34 kg/m2 vs. 37.62 kg/m2, p <0.001 respectively). The percent change in weight from baseline in the intervention group was a decrease of 3% compared to a decrease of 0.35% in the standard care group (p=0.03). Conclusions: Involvement of clinical pharmacist in interdisciplinary weight loss management through pharmacotherapy and other medication related services, shows considerable improvement in weight loss, when compared to the standard care of weight management. However, prospective randomized studies are warranted to further assess the benefits of a pharmacist-driven, interdisciplinary weight loss service.

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