Adding obesity to the problem list increases the rate of providers addressing obesity.

BACKGROUND AND OBJECTIVES: Obesity is a common problem that increases risk of many other diseases, from heart disease to cancer. While counseling by a physician increases patient report of weight loss attempts and increased exercise, primary care physicians do not frequently address obesity. The objectives of this study were to determine how often obesity was included on the problem list and whether adding obesity to the problem list affected the rate at which it was addressed in future visits. METHODS: We conducted an initial assessment, followed by a randomized controlled trial of patient records at a family medicine residency office. The intervention was the addition of obesity to the problem list. The measured outcome was whether or not obesity was listed as an encounter diagnosis in the following 5 months. RESULTS: At baseline, 36.2% of obese patients had obesity on their problem list. A total of 55.5% of these patients had obesity addressed by a provider in the past year, compared with 5.1% of patients who did not have obesity on their problem list. In the 5 months following the intervention, 38 (14.7%) of the 258 patients in the intervention group had obesity addressed, compared with 11 (4.6%) of the 239 patients in the control group. CONCLUSIONS: There is a significant relationship between the addition of obesity to the problem list and providers addressing obesity at future visits. This simple intervention could be accomplished automatically by the EMR and has the potential to change provider behavior

Low-Income African American Women\u27s Perceptions of Primary Care Physician Weight Loss Counseling: A Positive Deviance Study

The purpose of this study was to qualitatively and quantitatively evaluate the interactions between low-income, African American women who successfully lost weight and the healthcare system. This mixed methods study followed a positive deviance approach, identifying a population at high risk for obesity and then identifying positive deviants within this population. In this case, positive deviants were low-income, African American women who had been obese, and had successfully lost at least 10% of their weight and maintained this loss for at least six months. We collected data from electronic medical records (EMR) and participant surveys of both positive deviant cases, who had lost weight, and controls, who had not lost weight. To further evaluate these interactions, we conducted interviews with cases. We evaluated if physician documentation in the EMR of dietary counseling, a weight-related medical problem, or obesity were predictors of positive deviant group membership. We evaluated survey data to assess if participant report of physician counseling for weight loss, or a weight-related medical problem were predictors of positive deviant group membership. We found that physician documentation of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Documentation of obesity on the problem list was predictive of control group membership. Neither survey outcome was a significant predictor of positive deviant group membership. We identified four major themes from interviews with those who had lost weight: framing obesity in the context of other health problems provided motivation, having a full discussion around weight management was important, an ongoing conversation and relationship was helpful, and advice was helpful but only up to a point. In summary, physician counseling and having a weight related diagnosis were predictive of positive deviant group membership. Participants indicated a desire for more physician counseling and desired more specific guidance or referrals. No audio, only PowerPoint slides

Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis.

OBJECTIVE: We set out to investigate the behaviors of low-income African American women who successfully lost weight. METHODS: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. RESULTS: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. CONCLUSIONS: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations

Factors Associated with Clinician Adherence to USPSTF Diabetes Screening Recommendations

Introduction/Objectives: Diabetes and prediabetes impact nearly half of the US adult population and are associated with significant health risks but may be underdiagnosed. Effective screening may improve diagnosis and give patients opportunity to manage their disease. The purpose of this study was to determine screening rates, identify characteristics predictive of screening, and evaluate correct diagnosis of diabetes and prediabetes. Methods: Retrospective chart review of 71 433 patients eligible for diabetes screening, defined by completing A1c test within the 3-year study period. Results: A total of 31.3% of eligible patients received diabetes screening. Factors associated with screening include older age, female sex, non-white race, Hispanic ethnicity, Medicare or Medicaid insurance, higher BMI, and having a medical comorbidity. History of prediabetes or gestational diabetes were the strongest predictors for diabetes screening, but history of gestational diabetes was under-documented. Of those screened, 10.4% had a result consistent with diabetes and 51.8% had a result consistent with prediabetes. However, 52.9% of these patients had a missed diagnosis. Conclusions: Findings of this study indicate the need for uniform coverage for diabetes screening for all insurances, increased documentation of gestational diabetes to improve screening for patients with this history, and improving accurate diagnosis after screening is completed