Missed Opportunities: Documentation and Referral Rates Among Children and Adults with Obesity

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity. Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians. Results: For children with BMI \u3e95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI \u3e30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more subjects received referrals when obesity was on the PL (both age-groups) compared to those without (children: 20.2% vs 9.0%; adults: 12.12% vs 3.9%, p values \u3c 0.0001). Higher BMI and more comorbidities were also associated with higher referral rates (children: 26.6% vs 8.6% for those with a BMI ≥ 99 percentile; adults: 19.9% vs 5.8% for those with a BMI ≥ 40; children: 20.2% vs 10.7% for ≥ 1 comorbidity vs 1 or fewer; adults: 22.7% vs 5.1% with ≥ 3 comorbidities compared to 0 comorbidities). Discussion: The low rates of documentation of obesity and low rates of referral raise concern that providers may be missing opportunities to identify and manage their patients affected by obesity. Conclusions: Children and adults with obesity are more likely to be referred to a dietitian or obesity medicine specialist if obesity is on the PL, they have a higher BMI, and they have more medical comorbidities

Referral Patterns for Pediatric Sports-Related Concussion in One New England Health Care System

Introduction: Patients with concussion may benefit from care provided by professionals from multiple disciplines based on the constellation of symptoms being reported. This study analyzed referral patterns from primary care and sports medicine clinicians for pediatric patients with sports-related concussion in one health care system. Methods: A retrospective chart review identified referrals placed to physical therapy, occupational therapy, speech pathology, optometry, psychology, neuropsychology, audiology, neurology, ophthalmology, otolaryngology, psychiatry, and sports medicine for pediatric patients with sports-related concussion. These patients were evaluated at MaineHealth family medicine, internal medicine/pediatrics, pediatrics, and sports medicine clinics in southern Maine between February 2019 and June 2022. Results: We identified 375 patients with concussions. These patients were most often evaluated by pediatrics (199; 53.1%) and sports medicine (160; 42.7%), with fewer evaluated by family medicine (28; 7.5%), internal medicine/pediatrics (8 patients; 2.1%), or internal medicine (6; 1.6%). The most common referrals were to physical therapy (40; 10.7%), sports medicine (21; 5.6%), psychology (11; 2.9%), and neurology (9; 2.4%). Sports medicine placed a significantly higher number of referrals (P \u3c .0001) than non-sports medicine disciplines. Discussion: Compared to prior research, fewer referrals were placed in this cohort of patients with concussion. Possible explanations include a larger population of uncomplicated concussions, the more rural setting in which this study occurred, or a lack of awareness of resources for further concussion care. Conclusions: Further investigation should be done to evaluate the causes of the reduced referrals and their impact on the recovery of pediatric athletes with concussion

Physician Gender Impact on Obesity Care in the Academic Ambulatory Setting

BACKGROUND & OBJECTIVE: The purpose of this study was to assess a nationally representative sample of academic family physicians to determine whether personal physician characteristics are associated with attitudes towards and care of overweight and/or obese patients. METHODS: Questions pertaining to physician’s interactions with overweight and obese patients was administered as the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to academic family physicians. We analyzed self-reported demographic responses physicians gave with the main outcome the association between self-reported likelihood of engaging in weight loss discussions with overweight or obese patients and physicians’ personal characteristics (gender and physician BMI). RESULTS: 36% of the 1099 physicians surveyed were overweight and 14% were obese (Table 1). We found no differences in the self-reported likelihood of discussing weight loss strategies with either their overweight patients or obese patients by physician BMI category. 77% female vs. 64% male physicians reported being very/extremely likely to discuss weight loss with their obese patients at their most recent visit (p=0.002). Female physicians reported discussing weight loss strategies often or at every visit more than males (females 79%, males 69%; p=0.02). Finally, female physicians self-reported more minutes spent counseling overweight and obese patients (p = 0.0001) (Table 3). CONCLUSION: Female family medicine physicians are more likely than male counterparts to discuss weight loss strategies with obese patients and they report spending more time discussing weight loss strategies with their patients. However, self-reported physician BMI was not associated with these behaviors

Preference of Young Adult Cancer Survivors for In-Person Versus Telemedicine Cancer Survivorship Visits

Young adult (YA) cancer survivors face barriers to follow-up care, which can be exacerbated by living in a rural location. Telemedicine may mitigate these barriers, but little is known about the preferences of YA survivors for telemedicine or in-person survivorship visits. We surveyed 57 YA cancer survivors in a rural state to assess their preference for survivorship visits. Forty-six percent of respondents preferred an in-person visit while 16% preferred telemedicine. The remaining 39% reported it depends or were undecided. In-person visits were preferred when stratified by rural versus urban location. This work can be used to inform survivorship delivery systems

Effectiveness of Two Frequently Used Screening Tools in Identifying Depression and Anxiety in Collegiate Athletes

Introduction: To determine whether the Electronic Pre-participation Physical Examination (EPPE), a proprietary and frequently used tool, is an effective method for depression and anxiety screening in the collegiate athlete population as compared to the Patient Health Questionnaire-4 (PHQ-4). Methods: College athletes at a Division III university completed PHQ-4 questionnaires and a proprietary EPPE. Positive reponse rates to depression and/or anxiety for both questionnaires were collected and analyzed with a kappa (κ) statistic. Results: Among 420 students, we found that 9 (2%) reported depression and/or anxiety via the EPPE. Of the 26 students (6%) who answered positively on the PHQ-4, we found that 2 reported depression and/or anxiety on the EPPE. Of the 9 students who reported a history of depression and/or anxiety on the EPPE, we found that 2 scored positively on the PHQ-4. Agreement between the 2 methods was poor (κ = 0.08). Discussion: Reporting depression or anxiety among collegiate athletes with the EPPE screening question related to the nervous system is low compared to the PHQ-4. Conclusions: Colleges should consider adding additional depression and anxiety screening tools during the pre-participation exam to ensure they identify and treat at-risk student athletes