Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2021 Sep;36(9):2709-2716. doi: 10.1007/s11606-020-06548-w. Epub 2021 Feb 2.
Obesity is of epidemic proportion in the USA but most people with obesity do not receive treatment.
To explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. The study's focus was on examining the use of the Medicare payment code for intensive behavioral therapy for obesity (IBT), but other obesity management services and payment mechanisms were also studied.
DESIGN/PARTICIPANTS: We conducted 85 interviews of clinicians (physician, advanced practice clinicians, registered dietitian, or other) practicing in primary care practices. Interviews gathered information about treatment approach to obesity, barriers, and facilitators to providing obesity care including the handling of billing and reimbursement (especially use of the IBT code), personal beliefs about the appropriateness of primary care providing weight loss services, and recommendations for improving weight management in primary care practice. The analysis was conducted using a grounded theory hermeneutic editing approach and the constant comparative method.
Seventy-five interviews were included in this analysis. We identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile.
Treating obesity in primary care settings poses several challenges but can also be very satisfying and rewarding. To improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.
肥胖在美国已呈流行趋势，但大多数肥胖患者并未接受治疗。
探索初级保健临床医生及其参与初级保健实践中减肥的团队成员在提供肥胖管理方面的经验。该研究的重点是检查医疗保险对肥胖强化行为治疗（IBT）的支付代码的使用，但也研究了其他肥胖管理服务和支付机制。
设计/参与者：我们对在初级保健实践中执业的临床医生（医生、高级执业临床医生、注册营养师或其他）进行了 85 次访谈。访谈收集了有关肥胖治疗方法、提供肥胖护理的障碍和促进因素的信息，包括账单和报销的处理（特别是使用 IBT 代码）、个人对初级保健提供减肥服务的适当性的看法，以及改善初级保健实践中体重管理的建议。分析采用扎根理论阐释学编辑方法和恒比方法进行。
本分析纳入了 75 次访谈。我们确定了三个主要主题：（1）参与初级保健肥胖管理的临床医生和工作人员认为，解决肥胖问题是初级保健服务的重要组成部分；（2）由于提供肥胖护理具有挑战性，许多实践选择不进行治疗；（3）尽管存在挑战，但许多临床医生和其他人发现治疗肥胖是可行、令人满意和有价值的。
在初级保健环境中治疗肥胖症存在一些挑战，但也可能非常令人满意和有价值。为了提高临床医生和实践成员治疗肥胖症的能力，需要在支付、教育和工作流程方面进行重要的改革。
