Ren Vicky, Ellison Kathleen, Miller Jonathan, Busireddy Kiran, Vickery Erin, Panda Mukta, Qayyum Rehan
Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA.
Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
J Community Hosp Intern Med Perspect. 2016 Apr 25;6(2):30931. doi: 10.3402/jchimp.v6.30931. eCollection 2016.
Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic.
We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents.
We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables.
Of the 278 patients with BMI≥30 kg/m(2), 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05-1.11; P<0.001). In addition, as compared to postgraduate year (PGY) 1 residents, PGY-3 residents were 56% (OR=0.44; 95% CI=0.21-0.95; P=0.03) less likely to counsel obese patients.
Obesity is inadequately addressed in primary care settings, and didactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed.
建议对成年患者进行肥胖筛查，并提供适当的咨询和减肥治疗。然而，许多医疗服务提供者认为自己没有足够的能力来处理这个话题。
我们研究了教学讲座是否会增加内科住院医师对肥胖的记录及咨询。
我们回顾了2015年4月在内科住院医师连续性诊所就诊的患者的病历。2015年5月，住院医师在两次教学讲座中得到了反馈。为了检验这种干预的效果，我们在2015年6月再次进行了病历回顾。对于这两次回顾，我们提取了患者特定的（即年龄、体重指数[BMI]、种族、性别和合并症诊断数量）和住院医师特定的（即性别和培训水平）数据，以及肥胖记录和咨询的证据。我们使用逻辑回归模型来检验干预对肥胖记录和咨询的影响，并对患者和住院医师特定变量进行了调整。
在278名BMI≥30 kg/m²的患者中，139名在干预前就诊，139名在干预后就诊。无论是否对混杂变量进行调整，干预对肥胖记录或咨询均无影响（P均>0.05）。在调整后的事后分析中，每增加一种合并症，肥胖记录的几率增加8%（OR=1.08；95%CI=1.05-1.11；P<0.001）。此外，与第一年住院医师相比，第三年住院医师为肥胖患者提供咨询的可能性低56%（OR=0.44；95%CI=0.21-0.95；P=0.03）。
初级保健机构对肥胖问题的处理不足，教学讲座无法增加肥胖记录或减肥咨询。需要开展未来研究以确定有效的干预措施。
