Provider Views of the Feasibility and Utility of Lifestyle Obesity Treatment in Primary Care: Insights from the Think Health! Study

2015 ◽  
Vol 3 (1) ◽  
pp. 77 ◽  
Author(s):  
Etienne Phipps ◽  
Lisa Chacko ◽  
Jennifer Fassbender ◽  
Kelly Allison ◽  
David Sarwer ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Obesity Treatment ◽  
Weight Loss Program ◽  
Health Study ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Practice Based Research ◽  
Primary Care Clinicians ◽  
Post Hoc

Rationale:   Feasible approaches for providing obesity treatment in primary care settings have been difficult to identify. We assessed the views of primary care clinicians and practice staff about a simplified, lifestyle weight loss program after their participation in a randomized trial designed to evaluate the program within their clinical practices.  Methods: Post-hoc interviews were conducted with 13 clinicians and 12 auxiliary staff at the 5 participating practices in the Think Health! Study of weight management in primary care.  A 13-item survey was used to guide semi-structured interviews about the perceived strengths, weakness, and potential long-term utility of the program. Responses were analyzed using descriptive statistics and qualitative methods. Results:  Providers unanimously endorsed the need for weight loss counseling for their patients.  They supported the need for more frequent visits initially to best engage patients in a weight loss program.  Additional training in counseling skills was desired. Conclusion:  Clinicians participating in a practice- based trial valued having weight loss materials available to share with patients.  Offering patient materials that convey key content and structure for behavior change tasks while allowing provider discretion in how materials are integrated into patient care might be a viable option for testing in future practice-based research. 

scholarly journals How do physicians and nurses in family practice describe their care for patients with progressive life-limiting illness? A qualitative study of a ‘palliative approach’

2019 ◽  
Vol 20 ◽  
Author(s):  
Alex Rewegan ◽  
Sharef Danho ◽  
Joy White ◽  
Samantha Winemaker ◽  
Nicolle Hansen ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Functional Decline ◽  
Primary Care Providers ◽  
Care Providers ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Team Members ◽  
Palliative Approach ◽  
Primary Care Clinicians

Abstract Aim: To explore how a palliative approach to care is operationalized in primary care, through the description of clinical practices used by primary care clinicians to identify and care for patients with progressive life-limiting illness (PLLI). Background: Increasing numbers of people are living with PLLI but are often not recognized as needing a palliative approach to care. To meet growing needs, generalists such as family physicians will need to adopt a palliative approach to care in their own setting. Practical descriptions of a palliative approach in non-specialist settings have been lacking. Methods: We conducted a qualitative descriptive study design using in-depth semi-structured interviews with 11 key informant participants (6 physicians, 3 nurse practitioners, 1 registered nurse, and 1 registered practical nurse) known to be providing comprehensive care to patients with PLLI in family practices in Ontario, Canada. We asked about their approach to identifying patients with PLLI and the strategies used in their care. We employed content analysis to develop themes. Findings: Participants identified patients by functional decline, change in needs, increased acuity, and the specifics of a condition/diagnosis. Care strategies included concretizing commitment to care, eliciting goals of care, shifting care to the home, broadening team members including leveraging the support of family and community resources, and shifting to a ‘proactive’ approach involving increased follow-up, flexibility, and intensity. Conclusion: Primary care providers articulated strategies for identifying and providing care to patients with PLLI that illuminate an upstream approach tailored to their setting.

scholarly journals Effects of Vitamin D Status and Supplements on Anthropometric and Biochemical Indices in a Clinical Setting: A Retrospective Study

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 3032 ◽  
Author(s):  
Myriam Abboud ◽  
Xiaoying Liu ◽  
Flavia Fayet-Moore ◽  
Kaye E. Brock ◽  
Dimitrios Papandreou ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Weight Loss ◽  
Waist Circumference ◽  
Sun Exposure ◽  
Vitamin D Supplementation ◽  
Weight Loss Program ◽  
Vitamin D Status ◽  
Anthropometric Measures ◽  
Clinical Records

Context: Obesity and low vitamin D status are linked. It is not clear that weight loss through lifestyle intervention is influenced by vitamin D status. Objective: The aim of this study was to investigate the effect of baseline vitamin D status and vitamin D supplementation on weight loss and associated parameters for participants on a weight loss program in a primary care setting. Design: A retrospective analysis of clinical records of patients who underwent an individually tailored weight loss program at a single dietetic clinic in Sydney, Australia. Setting: Primary care centers. Patients: 205 overweight and obese men and women aged from 18 to 50 years. Interventions: Patients were referred to a dietetic clinic for a weight loss program. Patients with low serum 25-hydroxyvitamin D (25(OH)D) concentrations at baseline were advised to increase sun exposure and take multivitamins supplemented with 2000 IU or 4000 IU per day of vitamin D3, according to the preference of their primary care physician. Main outcome measures: Clinical parameters of weight, height, waist circumference, and serum 25(OH)D, as well as blood pressure and fasting lipid profile were collected from both baseline and three-month follow-up consultations. Results: Subjects with sufficient baseline 25(OH)D levels (≥50 nmol/L) experienced significantly greater weight loss (−7.7 ± 5.9 kg vs. −4.2 ± 3.3 kg) and reductions in BMI (−2.6 ± 1.8 kg/m2 vs. −1.5 ± 1.1 kg/m2) and waist circumference (−5.2 ± 3.5 cm vs. −3.1 ± 3.1 cm) as compared with those who were vitamin D insufficient at baseline (p < 0.001 for all). Vitamin D insufficient patients who were supplemented with daily 2000 IU or 4000 IU vitamin D experienced significantly greater decreases in weight (−5.3 ± 3.6 kg vs. −2.3 ± 1.6 kg), BMI (−1.9 ± 1.2 kg/m2 vs. −0.8 ± 0.6 kg/m2) and waist circumference (−4.2 ± 3.4 cm vs. −1.2 ± 1.3 cm) as compared with those not supplemented (p < 0.001 for all). We also observed a greater decrease in low-density lipoprotein (LDL) cholesterol (−0.4 ± 0.5 mmol/L vs. −0.2 ± 0.5 mmol/L) in subjects insufficient at baseline and supplemented as compared with those insufficient at baseline and not supplemented (p < 0.01). Conclusion: In a weight loss setting in a dietetic clinic, adequate vitamin D status at baseline, or achieved at three months through supplementation, was associated with significantly greater improvement of anthropometric measures. The study has implications for the management of vitamin D status in obese or overweight patients undergoing weight loss programs.

scholarly journals EFFICACY OF A PRIMARY CARE MANAGED WEIGHT LOSS PROGRAM IN OVERWEIGHT AND OBESE WOMEN

2002 ◽  
Vol 34 (5) ◽  
pp. S73
Author(s):  
L Marsh ◽  
A Zuckerman ◽  
A Faul ◽  
P Martin ◽  
M A. Welsch
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Weight Loss Program ◽  
Obese Women

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.

Speaking of weight: how patients and primary care clinicians initiate weight loss counseling

2004 ◽  
Vol 38 (6) ◽  
pp. 819-827 ◽  
Author(s):  
John G Scott ◽  
Deborah Cohen ◽  
Barbara DiCicco-Bloom ◽  
A.John Orzano ◽  
Patrice Gregory ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Primary Care Clinicians

scholarly journals Dementia Diagnosis and Challenges in Minority Populations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 161-162
Author(s):  
Halima Amjad ◽  
Marcela Blinka ◽  
Jennifer Aufill ◽  
Quincy Samus
Keyword(s):  
Primary Care ◽  
Minority Groups ◽  
The United States ◽  
Theory Approach ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Starting Point ◽  
Care Relationships ◽  
Grounded Theory Approach ◽  
Poor Memory

Abstract Alzheimer’s disease and related dementias are underdiagnosed in the United States, with potentially higher rates of underdiagnosis among minority groups. Our objective was to examine perceptions of dementia, the utility and timeliness of diagnosis, and experiences obtaining diagnosis and care in minorities. We recruited 17 family caregivers of African American (n=11), Latino (n=3), and Asian (n=3) persons with dementia (PWD) to complete surveys and semi-structured interviews. Caregivers were mostly female (n=14), children of PWD (n=14), and had greater than high school education (n=16). Mean PWD age at diagnosis was 76 years (range 63-90) with mean 17 months from symptom observation to diagnosis (range 0.5-36 months). Interview themes were coded using a grounded theory approach. Emerging themes related to concerns prior to diagnosis, diagnosis experiences, timeliness of diagnosis, ways to improve diagnosis and care, familiarity with dementia, and stigma. Poor memory was the most common early concern; caregivers also noted behavioral symptoms, weight loss, family stress, and PWD vulnerability. Caregivers recalled key moments when they knew something was wrong. Primary care was the most frequent starting point in diagnosis; longstanding primary care relationships both facilitated and hindered diagnosis. Nine of the 17 caregivers felt diagnosis was delayed. Caregivers preferred clinicians who were forthcoming with the diagnosis and what to expect and noted the importance of family meetings or counseling. Prior experience or knowledge of dementia was common. Caregiver perspectives and experiences elicited in this study may be translated to interventions and clinical practices that proactively detect and address dementia in minorities.

scholarly journals Evaluation of a Primary Care Weight Loss Program

2017 ◽  
Vol 10 (1) ◽  
pp. 79-84
Author(s):  
Callie Schlicht ◽  
Christine Shaw ◽  
Kristin Haglund ◽  
Susan Breakwell
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Nurse Practitioners ◽  
Chart Review ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Weight Loss Program ◽  
Strong Positive Correlation ◽  
Care Clinic

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

scholarly journals Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e586-e594 ◽  
Author(s):  
Eddie Donaghy ◽  
Helen Atherton ◽  
Victoria Hammersley ◽  
Hannah McNeilly ◽  
Annemieke Bikker ◽  
...  
Keyword(s):  
Primary Care ◽  
Visual Cues ◽  
Mental Health Problems ◽  
Structured Interviews ◽  
Time Saving ◽  
Technical Problems ◽  
Work Demand ◽  
Face To Face ◽  
Visual Component ◽  
Primary Care Clinicians

BackgroundPeople increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode.AimTo explore patients’ and clinicians’ experiences of VC.Design and settingSemi-structured interviews in UK primary care.MethodPrimary care clinicians were provided with VC equipment. They invited patients requiring a follow-up consultation to an online VC using the Attend Anywhere web-based platform. Participating patients required a smartphone, tablet, or video-enabled computer. Following VCs, semi-structured interviews were conducted with patients (n = 21) and primary care clinicians (n = 13), followed by a thematic analysis.ResultsParticipants reported positive experiences of VC, and stated that VC was particularly helpful for them as working people and people with mobility or mental health problems. VCs were considered superior to telephone consultations in providing visual cues and reassurance, building rapport, and improving communication. Technical problems, however, were common. Clinicians felt, for routine use, VCs must be more reliable and seamlessly integrated with appointment systems, which would require upgrading of current NHS IT systems.ConclusionThe visual component of VCs offers distinct advantages over telephone consultations. When integrated with current systems VCs can provide a time-saving alternative to face-to-face consultations when formal physical examination is not required, especially for people who work. Demand for VC services in primary care is likely to rise, but improved technical infrastructure is required to allow VC to become routine. However, for complex or sensitive problems face-to-face consultations remain preferable.

scholarly journals 188 Senior clinical and business managers’perspectives on how different mechanisms and models of employing general practitioners in or alongside Emergency Departments influence wider system outcomes

2020 ◽  
Vol 37 (12) ◽  
pp. 840.3-841
Author(s):  
Mazhar Choudrhey ◽  
Michelle Edwards ◽  
Alison Cooper ◽  
Pippa Anderson ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Service ◽  
Local Context ◽  
Service Development ◽  
Structured Interviews ◽  
Flow Of Funds ◽  
Funding Mechanisms ◽  
Primary Care Clinicians ◽  
Gp Model

Aims/Objectives/BackgroundWe aim to examine senior managers’ perspectives on funding mechanisms used to implement the policy and experiences of success or challenges in introducing models of using GPs in or alongside emergency departments. Health policy in England has advocated the use of primary care clinicians at emergency departments to address pressures from rising attendances. However, implementing large systemic changes such as placing GPs in or alongside emergency departments requires significant funding, consideration of the opportunity costs of the alternative uses of such funding, an available workforce and evidence of how it should be used. Our findings will inform policy adaptation and service development to improve the healthcare provided to patients by providing new evidence of the reported experiences of adopting models of using GPs in or alongside emergency departments.Methods/DesignThe perspectives of senior clinical, business and finance managers with responsibility for emergency department services and on-site primary care service implementation were investigated in semi-structured interviews with 31 managers at 12 type-1 emergency departments in England and Wales. Emergency departments operated one of three GP models or had prior experience of implementing a GP model. Interviews were thematically analysed.Results/ConclusionsSuccessful GPs models in emergency departments were perceived to be reliant on well-organised and unified funding mechanisms, appropriate staffing and governance, and consideration of population demands and needs. Funding mechanisms and the flow of funds were reported as complex, the most efficient mechanisms were described at departments where funding was unified, in collaboration with health and community care services. Staffing with local, experienced GPs was important. There were also cautions from experiences with private locum providers. Our findings contribute to debates about implementing policy on how primary care clinicians are effectively and safely deployed in emergency departments and how local context should be considered.

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