scholarly journals Sharing the ‘weight’ of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients

2020 ◽  
Author(s):  
Molly Jacobs ◽  
Jordan Harris ◽  
Kay Craven ◽  
Lauren Sastre
Keyword(s):  
Primary Care ◽  
Body Mass Index ◽  
Treatment Group ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Fixed Effects ◽  
Care Setting ◽  
Primary Care Setting ◽  
Control Group ◽  
Registered Dietitian

Abstract Background Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes. Objectives The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors. Methods A case–control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2. Results Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time. Conclusions Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.

scholarly journals Exploring the Type 2 Diabetes Management in the Primary Care Setting in Ratchaburi Province, Thailand

2019 ◽  
Vol 12 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Phenchamat Khamthana ◽  
Yaowaluck Meebunmak ◽  
Issara Siramaneerat
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Body Mass Index ◽  
Body Mass ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diabetes Management ◽  
Care Practice ◽  
District Health

Purpose:We aimed to describe the outcomes of primary care setting of type 2 diabetes patient at Sub-District Health Promoting Hospital (SDHPH).Methods:This study was a cross-sectional study on 1,890 patients with type 2 diabetes who were participating in the primary care research networks in the Ratchaburi Province of Thailand. Data was obtained through a self-administered questionnaire about the state of health and care. Patient medical records were used to examine the condition of complications, treatment and several indicators of DM care. The data was processed by using logistic regression to analyse the effect of independent variables on the dependent variable. The hypothesis-null was rejected at p-values <0.05.Results:The participants in this study were of age 57.56 years (SD=12.10), and most (55.58%) were female. Most respondents (36.20%) completed a Bachelor’s degree and were working as employees (28.35%). Regarding duration of diabetes, the majority (28.35%) had 11-20 years. In terms of body mass index, 29.67% had body mass index between 25.0-29.9 (overweight). Regarding complications and comorbidities, the common complication and comorbidity was nephropathy (33.63%) while Ischemic heart disease was the major of other comorbid health problems (48.3%). Furthermore, patients were mostly taking Antihypertensive (67.80%) and ACE Inhibitor or ARB (59.00%). The majority of HbA1c level (42.74%) was lower than 7.0%. Regarding the logistic analysis, it showed that education and treatment significantly influenced Hemoglobin A1c level at significant levels of 0.05.Conclusion:Only modest numbers of patients achieved established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve health care.

scholarly journals Body Mass Index Assessment of Health Care Professionals in a Primary Care Setting in Portugal: a Cross Sectional Study

2014 ◽  
Vol 27 (5) ◽  
pp. 609 ◽  
Author(s):  
Inês Campos-Matos ◽  
André Peralta-Santos ◽  
Bernardo Gomes ◽  
Gustavo Borges ◽  
Pedro Aguiar
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Body Mass Index ◽  
Primary Health Care ◽  
Body Mass ◽  
Health Care Professionals ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional ◽  
Primary Health

<p><strong>Introduction:</strong> Obesity is an important public health problem because it is a risk factor for numerous diseases and is associated with a higher death risk. Evidence concerning the prevalence of excess weight in health professionals is scarce and this group is often overlooked in weight interventions programs. This paper aims to estimate the prevalence of obesity and overweight among Portuguese primary health care professionals and to describe differences between occupational groups.<br /><strong>Material and Methods:</strong> This was a cross sectional study based on a primary care setting in Portugal in 2011. We collected data on occupation, age, sex and height of professionals from four primary care centers. We did a descriptive analysis of the main variables and an analysis of covariance to compare mean Body Mass Index.<br /><strong>Results:</strong> Our sample represented 52.8% of the total population of the four primary care centers, and 38.6% were overweight and 16.9% were obese. When adjusted for age and gender, health service personnel had the highest average Body Mass Index, followed by nurses, physicians, and superior technicians, in that order.<br /><strong>Discussion:</strong> Although we can’t ensure the generalisation of the results and cannot exclude the possibility of sampling bias, these results suggest high prevalence obesity and overweight in workers of primary health care in Portugal.<br /><strong>Conclusion:</strong> In this primary care setting more than half of the health care professionals were overweight or obese. Tailored interventions might be needed to tackle this issue.</p><p><br /><strong>Keywords:</strong> Body Mass Index; Health Personnel; Obesity; Portugal; Primary Health Care; Prevalence.</p>

scholarly journals Efficacy of Traditional Chinese Medicine in Treatment and Prophylaxis of Radiation-Induced Oral Mucositis in Patients Receiving Radiotherapy: A Randomized Controlled Trial

2017 ◽  
Vol 17 (2) ◽  
pp. 444-450 ◽  
Author(s):  
Cong Wang ◽  
Peiguo Wang ◽  
Huaqiang Ouyang ◽  
Jing Wang ◽  
Lining Sun ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Chinese Medicine ◽  
Treatment Group ◽  
Traditional Chinese Medicine ◽  
Body Mass ◽  
Oral Mucositis ◽  
Visual Analysis ◽  
Control Group ◽  
Oral Pain ◽  
Radiation Induced

Objective: To estimate the efficacy of traditional Chinese medicine (Chining decoction, CHIN) for radiation-induced oral mucositis in patients with head and neck cancer. Methods: From May 2014 to December 2015, 70 consecutive patients were randomly assigned to receive CHIN (treatment group) or recombinant human epidermal growth factor (rhEGF) spray (control group) at a 1:1 ratio. CHIN was administered to treatment group from the first day of radiotherapy until the completion of radiotherapy. Simultaneously, the rhEGF spray was administered to control group on the oral mucosa of irradiated area. The clinical benefit was determined by gradation of mucositis (Common Terminology Criteria for Adverse Events v4.0), oral pain, and xerostomia (visual analysis scale) for each week during radiotherapy. Body mass index was evaluated before and after radiotherapy. Results: Patients in the treatment group had prominent remission of oral pain and grade of mucositis on each observing point compared with those in control group ( P < .01). Xerostomia was decreased notably in treatment group compared with control group ( P < .01). Body mass index in the treatment group exhibited advantage over control group after radiotherapy, but there was no statistical significance (19.8 ± 3.26 vs 18.8 ± 2.5 kg/m2, P = .153, >.05). Conclusions: CHIN presented an obvious advantage in preventing radiation-induced oral mucositis compared with rhEGF spray.

scholarly journals Impact of a diabetes disease management program on quality of care and costs: propensity score-matched real-world data from Switzerland.

2020 ◽  
Author(s):  
Maria Carlander ◽  
Marc Hoeglinger ◽  
Maria Trottmann ◽  
Birgitta Rhomberg ◽  
Cornelia Caviglia ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Propensity Score ◽  
Guideline Adherence ◽  
Care Setting ◽  
Primary Care Setting ◽  
Management Program ◽  
Control Group

Objectives Structured treatment programs have been recommended for management of patients with chronic conditions to overcome ill-coordinated care. We aimed to evaluate a disease management program (DMP) with for diabetes mellitus in Switzerland. Methods We performed a prospective observational study with a propensity score-matched usual care control group from a claims database. We included type-1 and type-2 diabetes patients from a primary care setting. The DMP (intervention) comprised a structured treatment approach with an individual treatment plan, treatment goals and an interprofessional team approach. Our outcome comprehensive measures included quality of life (QOL: EQ-5D-5L), pre-defined indicators for diabetes guideline adherence, number of used services and direct medical costs. We applied a difference-in-difference (DID) approach to compare DMP with usual care (follow-up 1 year). Costs were calculated with non-parametric bootstrapping (2017 Swiss Francs, CHF; conversion rate to Euros: 0.85) from a third-party payer perspective (Swiss health care insurance). Results QOL in a sub-sample of 80 patients did not change during follow-up (mean utility 0.89 at baseline and follow-up; p=0.94). Guideline adherence showed slight improvements for DMP. For example, non-adherence (baseline DMP: 19%) decreased in the DMP group by -3 %-points (DID; 95%-CI: -0.07 to 0.01) but not in the control group. A general trend emerged, though mostly not statistically significant, with less used services in the DMP group compared to the control group. Costs increased in both groups during follow-up, but the increase was higher in the control group (DID, mean total costs per patient per year: CHF -950.00 [95%-CI: -1959.53 to 59.56]). Such a negative difference-in-difference estimate in favor of DMP also emerged for cost sub-categories (e.g. costs for inpatient and outpatient care). Conclusions The structured treatment program under evaluation is a promising approach to improve diabetes care in a Swiss primary care setting but more follow-up data are needed.

The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics

2020 ◽  
Author(s):  
Vivienne A Rose ◽  
Elena N Klyushnenkova ◽  
Min Zhang ◽  
Verlyn O Warrington
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Practice ◽  
Primary Care Setting ◽  
Weight Loss Program ◽  
Care Practice ◽  
Control Group ◽  
Baseline Weight ◽  
Medical Weight Loss

Abstract Background Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. Objective To determine whether participation in the MWLP within a general primary care setting can result in weight loss. Methods A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015–31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. Results MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P &lt; 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. Conclusion MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.

scholarly journals Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

2020 ◽  
Vol 8 (B) ◽  
pp. 470-479
Author(s):  
Maryam Hannah Daud ◽  
Anis Safura Ramli ◽  
Suraya Abdul-Razak ◽  
Jamaiyah Haniff ◽  
Tg Mohd Ikhwan Tg Abu Bakar Sidik ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Controlled Trial ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Control Groups

AIM: The objective of this study was to evaluate the effectiveness of the EMPOWER- participatory action research (PAR) intervention, a multifaceted strategy based on the chronic care model (CCM) on primary care providers (PCP)’ adherence to type 2 diabetes mellitus (T2DM) clinical practice guideline (CPG) in the Malaysian primary care setting. METHODS: This was a pragmatic cluster randomized controlled trial –PAR conducted in ten public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. The outcome measure was the absolute change in the proportion of PCP’s adherence to T2DM CPG captured using the “Indicators of Care Pro forma,” based on the recommendation by the Malaysian CPG on the Management of T2DM. Data were collected from the patients’ medical records, at baseline and at 1-year follow-up; and were analyzed using mixed method model. RESULTS: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 were in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the absolute change in the proportion of PCPs’ adherence to T2DM CPG in the intervention group compared to the control group at 1-year follow-up in several indicators of care. These included the recording of BMI (0.6% vs. −1.8%, p<0.001); performing foot examination (2.4% vs. 0.6%, p<0.001); performing funduscopy/fundus photography (1.5% vs. 0.3%, p<0.001); monitoring renal profile (0.9% vs. −0.6%, p=0.001); measuring urine protein (1.2% vs. 0.6%, p<0.001), and giving lifestyle modification and self-management advice (1.2% vs. −0.3%, p<0.001) in the intervention versus control groups, respectively. CONCLUSION: The EMPOWER-PAR intervention has been proven to be effective in improving the PCPs’ adherence to T2DM CPG in several indicators of care. Findings from this study provided objective evidence of the effectiveness of multifaceted intervention based on the CCM in the Malaysian public primary care setting. TRIAL REGISTRATION: Registered with: ClinicalTrials.gov: NCT01545401. Date of registration: 1st March 2012.

scholarly journals The Effect of the Transtheoretical Model Approach Towards the Body Mass Index of Overweight and Obese Children in Makassar

2014 ◽  
Vol 6 (1) ◽  
pp. 51
Author(s):  
Kadek Ayu Erika
Keyword(s):  
Body Mass Index ◽  
Treatment Group ◽  
Body Mass ◽  
Transtheoretical Model ◽  
Health Risk Behaviors ◽  
Overweight And Obesity ◽  
The Body ◽  
Control Group ◽  
Research Subjects ◽  
Obese Children

BACKGROUND: Overweight and obesity is now ranked fifth as a global risk for the cause of death. Urban lifestyle is fueled by excessive food intake and lack of activity in overweight and obese children. The assessment of the children’s Body Mass Index (BMI) is one of the indicators to assess the nutritional status of children. One strategy that can be used is the transtheoretical model (TTM) approach which is behavior change that helps children and parents in making more effective decisions to reduce health-risk behaviors among children so that the children’s BMI can decrease. This study aims to identify the differences between children's BMI before and after the TTM approach.METHODS: This research was conducted in the district area of Tamalanrea and Biringkanaya, Makassar. The design used is the Quasy Experiment namely pre- and post-test with control group design. Research subjects were overweight or obese children in the 4th, 5th, and 6th grade of elementary school. The samples in the treatment group consisted of 31 participants, while the control group consisted of 33 participants which were selected using purposive sampling. Intervention research was conducted during a six month period by providing guide books on healthy lifestyle, visiting the families every month using questionnaires, and measurements of children’s height, weight and BMI using WHO’s AntrhoPlus software year 2007.RESULTS: Post-pretest results showed the average value of the treatment group’s BMI was -1.48 and the control group was 1.35. This means that the treatment group experienced a decrease in BMI after the application of TTM. The Mann Whitney test results indicate that there is a difference in the BMI pre-post intervention with the value of p=0.00 (>0.05).CONCLUSION: The overweight and obese children’s BMI was influenced by TTM approach.KEYWORDS: transtheoretical model, children’s BMI, overweight, obesity

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