Imoisili Omoye E, Goodman Alyson B, Dooyema Carrie A, Park Sohyun, Harrison Megan, Lundeen Elizabeth A, Blanck Heidi
Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Front Pediatr. 2018 Dec 12;6:367. doi: 10.3389/fped.2018.00367. eCollection 2018.
Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample. This cross-sectional study used data from the 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management. About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators. This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families.
儿童肥胖症护理管理方案可在社区、诊所和医院环境中实施。此前，临床医生向这些不同环境的转诊做法在地方层面以外尚未得到描述。本研究描述了在一个地域多样的样本中，照顾肥胖儿科患者的临床医生的管理策略和转诊做法以及相关的临床医生特征。这项横断面研究使用了2017年对891名诊治儿科患者的临床医生进行的基于面板的调查数据。为了进行儿科体重管理，我们使用多变量逻辑回归来估计临床医生的人口统计学和执业特征与转诊类型之间的关联。约一半（54%）接受调查的临床医生将不到25%的肥胖儿科患者转诊以进行体重管理。只有15%的临床医生将大多数（≥75%）肥胖儿科患者转诊以进行体重管理。转诊类型包括临床转诊、行为转诊和体重管理项目（WMP）转诊。在这些类别中，转诊百分比从行为/心理健康专业人员的19%到注册营养师的72%不等。在显著关联中，女性临床医生转诊到社区和临床WMP的几率更高；东北部的执业机构转诊到专科医生、营养师、心理健康专业人员和临床WMP的几率更高；每周进行≥15次健康儿童检查的诊所转诊到专科医生、心理健康专业人员和健康教育工作者的几率更高。与教学医院没有附属关系以及为低收入患者服务与转诊到心理健康专业人员、社区和临床WMP的几率较低有关。与儿科医生相比，家庭医生、内科医生和执业护士向心理健康专业人员和健康教育工作者转诊的几率更高。本研究有助于描述照顾肥胖儿科患者的临床医生当前的转诊做法和管理策略情况。我们的数据提供了与儿童肥胖症转诊类型相关的临床医生、临床实践和报告的患者特征方面的见解。了解转诊模式和管理策略可能有助于改善对肥胖儿童及其家庭的护理。
