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 < 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.

Abstract 226: Integration of Traditional and Alternate Chronic Care Models within a Primary Care Setting for Diabetes Management and Cardiovascular Disease Prevention

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mohan Thanikachalam ◽  
G Shanmugasundar ◽  
Muthuswamy Ravikiran ◽  
Vijaykumar Harivanzan ◽  
Sripriya Ravi
Keyword(s):  
Primary Care ◽  
Blood Sugar ◽  
Care Setting ◽  
Primary Care Practice ◽  
Diabetes Management ◽  
Self Management ◽  
Care Practice ◽  
Control Group ◽  
Management Support ◽  
Care Models

Background: Several chronic care models (CCMs) for diabetes management and cardiovascular disease prevention have been implemented, but outcomes have been marginal. Traditionally, CCMs have been offered within the trusted primary care practice environment, but self-management support is episodic, cost ineffective and difficult to scale. Alternate CCMs that offer self-management support mostly through telephone coaching or virtual (web/mobile platforms) interventions, enable easy access, scalability and cost effectiveness, yet are impaired by the limits of isolated self-management support when provided outside the context of the trusted, therapeutic relationship of a primary care practice. We hypothesize that an integrated model taking advantage of positive aspects of traditional and alternate CCMs will lead to positive behavioral change (empowerment), sustained patient participation and better outcomes. Methods: To test this hypothesis, we implemented the Empowerment and Participatory Care Model (EPCM) in a study center in Chennai, India by integrating face-to-face support with customized telephone, Internet and mobile phone enabled interventions within a primary care setting. Patients who participated in the traditional CCM formed the control group. Results: In the participents in traditional CCM (n=422), there was an average reduction of 0.57% in HbA1c, 16 mg/dl in fasting blood sugar, 30 mg/dl in post prandial blood sugar and 16 mg/dl of LDL at the end of year-one. In comparison, among the patients (66% men; mean age 52 yrs) who participated in the EPCM and had completed one-year in the program (n=112) there was average reduction of 1.6% in HbA1c, 57 mg/dl in fasting blood sugar, 80 mg/dl in post prandial blood sugar and 18 mg/dl of LDL (p<0.01). Figure 1 shows the difference in percent reduction of the various biochemical parameters between the EPCM and the control group. The total cost of care (other than medication) per patient per year in the EPCM, after taking into consideration purchasing power parity between USA and India, was 900 USD. Conclusion: The persons with diabetes who participated in the EPCM had better quality of metabolic control, but long-term follow up is required to assess overall reduction in the risk of cardiovascular complications and cost effectiveness.

Abstract #1003244: The Weight of Time: Achievements and Challenges of a Physician-Led Weight Loss Program in a Primary Care Setting

2021 ◽  
Vol 27 (6) ◽  
pp. S79-S80
Author(s):  
Aleksandra Sliwinska ◽  
Srinath Ramanan ◽  
Varalakshmi Niranajan ◽  
Helen Wu ◽  
Fufei Chen ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Setting ◽  
Weight Loss Program

scholarly journals Effectiveness of a Single Physician-led Weight loss Program in Primary Care Setting

2021 ◽  
Author(s):  
Varalakshmi Niranjan ◽  
Aleksandra Sliwinska ◽  
Fufei Chen ◽  
Srinath Ramanan ◽  
Narinder Maheshwari ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Retrospective Analysis ◽  
Weight Change ◽  
Care Setting ◽  
Primary Care Setting ◽  
Weight Loss Program ◽  
Time Period ◽  
Percentage Weight ◽  
Weight Loss Interventions

Abstract Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.

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.

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 SEXUAL DYSFUNCTION AMONG WOMEN AT FOUR TO SIX MONTHS POSTPARTUM: A STUDY IN A PRIMARY CARE SETTING

2020 ◽  
Vol 20 (1) ◽  
pp. 235-243
Author(s):  
Norafini Salamon ◽  
Syahnaz Mohd Hashim ◽  
Norfazilah Ahmad ◽  
Suzaily Wahab
Keyword(s):  
Primary Care ◽  
Sexual Dysfunction ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Cross Sectional ◽  
Maternal Characteristics ◽  
Local Setting ◽  
Arousal Disorder

Sexual dysfunction in women is a significant health problem that harms marriage stability. Women in the Western countries were reportedly being affected by this condition after childbirth but the magnitude of the problem in our local setting is still unknown. The aim of this cross-sectional study was to determine the prevalence of women with sexual dysfunction at four to six months postpartum and its possible risk factors in an urban primary care setting. The participants were given a set of questionnaire, consisting of three parts; i) sociodemographic and maternal characteristics ii) Malay version of Female Sexual Function Index and iii) Malay DASS-21 questionnaire. Responses from 249 women were analyzed. More than half (57.0%,n=142) were found to have sexual dysfunction. The most prevalent types of sexual dysfunction reported by the affected women were sexual satisfaction disorder (98.6%), followed by arousal disorder (58.5%) and lubrication disorder (28.9%). Three factors were found to be significantly associated with sexual dysfunction; household income of less than RM2000 (adj OR = 0.31, 95% CI 0.14, 0.70), Malay ethnic group (adj OR = 1.93,95% CI 1.02, 3.66) and breastfeeding (adj OR = 2.24,95% CI 1.03, 4.85). In conclusion, the prevalence of sexual dysfunction in the postpartum period was considerably high. Efforts should be made to incorporate sexual health as part of the routine postnatal assessment in primary care practice.

Identifying key roles of the pharmacy technician in primary care settings

2021 ◽  
Author(s):  
Shannon Gadd ◽  
Conrad E Lopez ◽  
Cory A Nelson ◽  
Trung Q Le ◽  
Cynthia S Valle-Oseguera ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Professional Judgment ◽  
Free Text ◽  
Pharmacy Technician ◽  
Pharmacy Technicians ◽  
Patient Outreach

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose As the pharmacist’s role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist’s professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. Methods The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. Results Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. Conclusion Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

scholarly journals Lessons learnt from a single physician‐led weight loss programme in primary care setting

2021 ◽  
Vol 75 (10) ◽  
Author(s):  
Varalakshmi Niranjan ◽  
Aleksandra Sliwinska ◽  
Fufei Chen ◽  
Srinath Ramanan ◽  
Narinder Maheshwari ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Setting ◽  
Lessons Learnt ◽  
Weight Loss Programme
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