Noël Polly Hitchcock, Copeland Laurel A, Pugh Mary Jo, Kahwati Leila, Tsevat Joel, Nelson Karin, Wang Chen-Pin, Bollinger Mary J, Hazuda Helen P
VERDICT/South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, USA.
J Gen Intern Med. 2010 Jun;25(6):510-6. doi: 10.1007/s11606-010-1279-z. Epub 2010 Feb 24.
In response to dramatic increases in obesity prevalence, clinical guidelines urge health care providers to prevent and treat obesity more aggressively.
To describe the proportion of obese primary care patients receiving obesity care over a 5-year period and identify factors predicting receipt of care.
Retrospective cohort study utilizing VHA administrative data from 6 of 21 VA administrative regions.
Veterans seen in primary care in FY2002 with a body mass index (BMI) > or =30 kg/m(2) based on heights and weights recorded in the electronic medical record (EMR), survival through FY2006, and active care (1 or more visits in at least 3 follow-up years FY2003-2006).
Receipt of outpatient visits for individual or group education or instruction in nutrition, exercise, or weight management; receipt of prescriptions for any FDA-approved medications for weight reduction; and receipt of bariatric surgery.
Of 933,084 (88.6%) of 1,053,228 primary care patients who had recorded heights and weights allowing calculation of BMI, 330,802 (35.5%) met criteria for obesity. Among obese patients who survived and received active care (N = 264,667), 53.5% had a recorded obesity diagnosis, 34.1% received at least one outpatient visit for obesity-related education or counseling, 0.4% received weight-loss medications, and 0.2% had bariatric surgery between FY2002-FY2006. In multivariable analysis, patients older than 65 years (OR = 0.62; 95% CI: 0.60-0.64) were less likely to receive obesity-related education, whereas those prescribed 5-7 or 8 or more medication classes (OR = 1.41; 1.38-1.45; OR = 1.94; 1.88-2.00, respectively) or diagnosed with obesity (OR = 4.0; 3.92-4.08) or diabetes (OR = 2.23; 2.18-2.27) were more likely to receive obesity-related education.
Substantial numbers of VHA primary care patients did not have sufficient height or weight data recorded to calculate BMI or have recorded obesity diagnoses when warranted. Receipt of obesity education varied by sociodemographic and clinical factors; providers may need to be cognizant of these when engaging patients in treatment.
为应对肥胖患病率的急剧上升，临床指南敦促医疗保健提供者更积极地预防和治疗肥胖症。
描述5年期间接受肥胖症护理的肥胖初级保健患者的比例，并确定预测接受护理的因素。
利用21个退伍军人事务部（VA）行政区中6个行政区的VA行政数据进行回顾性队列研究。
2002财年在初级保健中就诊的退伍军人，根据电子病历（EMR）中记录的身高和体重，体重指数（BMI）≥30kg/m²，存活至2006财年，并在2003 - 2006财年的至少3个随访年中有1次或更多次就诊（即接受积极护理）。
接受关于营养、运动或体重管理的个人或团体教育或指导的门诊就诊；接受任何美国食品药品监督管理局（FDA）批准的减肥药物处方；以及接受减肥手术。
在1,053,228名有记录身高和体重可计算BMI的初级保健患者中，933,084名（88.6%）符合肥胖标准。在存活且接受积极护理的肥胖患者（N = 264,667）中，53.5%有记录的肥胖诊断，34.1%接受了至少一次与肥胖相关的教育或咨询门诊就诊，0.4%接受了减肥药物治疗，0.2%在2002财年至2006财年期间接受了减肥手术。在多变量分析中，65岁以上的患者（OR = 0.62；95%CI：0.60 - 0.64）接受肥胖相关教育的可能性较小，而那些被开具5 - 7种或8种及以上药物类别（OR分别为1.41；1.38 - 1.45；OR = 1.94；1.88 - 2.00）、被诊断为肥胖（OR = 4.0；3.92 - 4.08）或糖尿病（OR = 2.23；2.18 - 2.27）的患者接受肥胖相关教育的可能性更大。
大量VA初级保健患者没有足够的身高或体重数据来计算BMI，或在必要时没有记录的肥胖诊断。肥胖教育的接受情况因社会人口统计学和临床因素而异；提供者在让患者接受治疗时可能需要认识到这些因素。
