教育和经验对基层医疗提供者在实用试验中肥胖治疗观点的影响。
Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial.
机构信息
Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.
Division of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, USA.
出版信息
Obesity (Silver Spring). 2018 Oct;26(10):1532-1538. doi: 10.1002/oby.22223. Epub 2018 Sep 26.
OBJECTIVE
To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment.
METHODS
PCPs from four intervention clinics (PCP-I) and five control clinics (PCP-C) completed pre- and postintervention surveys on weight-loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP-I received patient updates and education about obesity management.
RESULTS
Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP-C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP-C: 8.37 [1.24]; P = 0.8; pre/post PCP-I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP-I (pre/post PCP-C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP-I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP-I (pre/post PCP-C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP-I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP-C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP-I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP-C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP-I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP-I.
CONCLUSIONS
PCPs initially overvalued exercise and undervalued weight-loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight-loss medications.
目的
考察为期 1 年的实用肥胖试验对初级保健提供者（PCP）治疗观点的影响。
方法
来自四个干预诊所（PCP-I）和五个对照诊所（PCP-C）的 PCP 在减重咨询、讨论肥胖治疗的舒适度以及干预措施的有效性方面完成了干预前后的调查；问题以 0 到 10 分的李克特量表评分。只有 PCP-I 收到了有关肥胖管理的患者更新和教育。
结果
80 名 PCP 完成了干预前调查（前：71%为女性，71%为医生）；82 名 PCP 完成了干预后调查（后：66%为女性，70%为医生）。PCP 对运动的讨论最舒适，无论在试验前后（前 PCP-C：8.22 [1.44]，平均[标准差（SD）]；后 PCP-C：8.37 [1.24]；P = 0.8；前/后 PCP-I：7.88 [1.51]与 7.80 [1.71]；P = 0.3）。PCP 最初对讨论苯丁胺/托吡酯延长释放（ER）最不舒适，但在试验后显著增加了舒适度，在 PCP-I 中更为明显（前/后 PCP-C：2.86 [2.66]与 3.73 [2.72]，P < 0.001；前/后 PCP-I：4.00 [2.57]与 6.17 [2.27]，P < 0.001）。试验后，PCP 均认为运动对减肥的效果显著降低，PCP-I 的效果比率降低幅度更大（前/后 PCP-C：7.73 [1.94]与 6.93 [2.35]，P = 0.017；前/后 PCP-I：6.27 [2.69]与 5.15 [2.31]，P = 0.001）。PCP 均认为苯丁胺（前/后 PCP-C：5.03 [2.05]与 5.50 [2.12]，P = 0.002；前/后 PCP-I：5.70 [1.64]与 6.83 [1.18]，P = 0.001）和苯丁胺/托吡酯 ER（前/后 PCP-C：3.91 [2.33]与 5.47 [2.54]，P < 0.001；前/后 PCP-I：5.58 [2.21]与 7.02 [1.47]，P < 0.001）的效果显著增加，但 PCP-I 的评分更高。
结论
PCP 最初高估了运动，低估了减肥药物。接受教育和经验的 PCP 对减肥药物的舒适度和有效性评价更高。
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