Dunlop Anne L, Leroy Zanie, Trowbridge Frederick L, Kibbe Debra L
Emory University School of Medicine, Department of Family & Preventive Medicine, Atlanta, GA 30322, USA.
Ambul Pediatr. 2007 Nov-Dec;7(6):453-7. doi: 10.1016/j.ambp.2007.07.006.
Pediatric primary care providers' adherence to recommendations for the assessment and management of childhood overweight is low. There are scarce data addressing how to improve provider practices. This study evaluated the effect of provider training and office-based tool dissemination on pediatric providers' assessment and management of childhood overweight.
Provider practices before and after training and office-based tool dissemination were compared. Participants were resident and faculty providers at 6 urban, community-based primary care clinics affiliated with an academic medical center. Three months after completion of two 1-hour training sessions, clinic sites were provided with tools in bulk, and office staff were coached to distribute the tools during patient encounters. Provider practices were ascertained by medical record abstraction at baseline and at 3 and 6 months. The proportion of medical records with documentation of recommended practices, including recording of body mass index percentile (BMI%), obtaining a nutrition-activity history, and providing nutrition-activity counseling, was compared with chi(2) tests and logistic regression.
During the initial 3 months after training, provider documentation of recommended practices did not significantly improve compared with baseline. During the subsequent 3 months, after office-based distribution of tools, provider documentation of recommended practices improved significantly compared with baseline (28.8% vs 11.6% for BMI% [P < .001], 80.2% vs 49.8% for nutrition-activity history [P < .001], and 47.7% vs 33.3% for nutrition-activity counseling [P < .001]).
Pediatric providers' adherence to recommendations for the assessment and management of childhood overweight may improve with provider training linked to the office-based distribution of tools to promote performance of recommendations.
儿科初级保健提供者对儿童超重评估和管理建议的遵循率较低。关于如何改善提供者实践的数据稀缺。本研究评估了提供者培训和在办公室发放工具对儿科提供者对儿童超重评估和管理的影响。
比较了培训和在办公室发放工具前后提供者的实践情况。参与者是隶属于一所学术医疗中心的6家城市社区初级保健诊所的住院医师和教员提供者。在完成两次1小时培训课程三个月后，向诊所批量提供工具，并指导办公室工作人员在患者就诊时发放这些工具。通过在基线、3个月和6个月时提取病历确定提供者的实践情况。使用卡方检验和逻辑回归比较有推荐实践记录的病历比例，包括记录体重指数百分位数（BMI%）、获取营养 - 活动史以及提供营养 - 活动咨询。
在培训后的最初3个月里，与基线相比，提供者对推荐实践的记录没有显著改善。在随后的3个月里，在办公室发放工具后，与基线相比，提供者对推荐实践的记录有显著改善（BMI%记录从11.6%提高到28.8%[P <.001]，营养 - 活动史从49.8%提高到80.2%[P <.001]，营养 - 活动咨询从33.3%提高到47.7%[P <.001]）。
通过与在办公室发放工具相关联的提供者培训以促进对建议的执行，儿科提供者对儿童超重评估和管理建议的遵循情况可能会得到改善。
