Rhee Kyung E, Kessl Stephanie, Lindback Sarah, Littman Marshall, El-Kareh Robert E
Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA.
Children's Primary Care Medical Group, San Diego, CA, USA.
BMC Health Serv Res. 2018 Jan 30;18(1):55. doi: 10.1186/s12913-018-2870-y.
Pediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care.
A mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network.
Barriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention.
While providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.
儿科医疗服务提供者是儿童肥胖症治疗的关键角色，但在初级保健机构中肥胖症管理的比例较低。本研究的目的是调查儿科医疗服务提供者对在初级保健机构中进行肥胖症管理的看法，并确定可能有助于提供此类护理的潜在资源和护理模式。
采用混合方法。对圣地亚哥县一个大型儿科网络的医疗服务提供者进行了四个焦点小组访谈。基于先验主题和新出现的主题，制定了一份问卷并分发给该网络中更多的医疗服务提供者。
进行肥胖症管理的障碍分为四类：医疗服务提供者层面/个人层面（例如，缺乏知识和信心）、基于实践/系统层面（例如，缺乏时间和资源）、家长层面（例如，积极性和后续跟进不足）以及环境层面（例如，缺乏资源获取途径）。解决方案围绕采用团队护理方法（配备个案管理员和健康教练）以及电子病历的改变展开，包括纳入最佳实践指南、提高文档记录的便捷性以及提供标准化的手册/资源。调查结果显示，只有23.8%的医疗服务提供者希望进行肥胖症的行为管理。最需要的支持是在办公室引入一名健康教育工作者来进行简短的行为干预。
虽然医疗服务提供者认识到在儿童健康检查期间解决体重问题的重要性，但他们不想独自进行肥胖症管理。未来改善儿童肥胖症健康结果的努力应考虑采用协作护理方法。
