Karabukayeva Aizhan, Anderson Jami L, Hall Allyson G, Feldman Sue S, Mehta Tapan
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Graduate Medical Education, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
JMIR Form Res. 2022 Jul 1;6(7):e37456. doi: 10.2196/37456.
Although cardiometabolic diseases are leading causes of morbidity and mortality in the United States, computerized tools for risk assessment of cardiometabolic disease are rarely integral components of primary care practice. Embedding cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) may assist with identifying and treating patients at greatest risk for developing cardiometabolic disease.
This study aimed to explore the current approach to medical management of obesity and the need for CMDS designed to aid medical management of people living with obesity, at risk of being obese, or diabetic at the point of care.
Using a general inductive approach, this qualitative research study was guided by an interpretive epistemology. The method included semistructured, in-depth interviews with primary care providers (PCPs) from university-based community health clinics. The literature informed the interview protocol and included questions on PCPs' experiences and the need for a tool to improve their ability to manage and prevent complications from overweight and obesity.
PCPs (N=10) described their current approaches and emphasized behavioral treatments consisting of combined diet, physical activity, and behavior therapy as the first line of treatment for people who were overweight or obese. Results suggest that beneficial features of CDSS include (1) clinically relevant and customizable support, (2) provision of a comprehensive medical summary with trends, (3) availability of patient education materials and community resources, and (4) simplicity and ease of navigation.
Implementation of a CMDS via a CDSS could enable PCPs to conduct comprehensive cardiometabolic disease risk assessments, supporting clinical management of overweight, obesity, and diabetes. Results from this study provide unique insights to developers and researchers by identifying areas for design optimization, improved end user experience, and successful adoption of the CDSS.
尽管心脏代谢疾病是美国发病和死亡的主要原因，但用于心脏代谢疾病风险评估的计算机化工具很少成为初级保健实践的组成部分。将心脏代谢疾病分期系统（CMDS）嵌入计算机化临床决策支持系统（CDSS）可能有助于识别和治疗发生心脏代谢疾病风险最高的患者。
本研究旨在探讨当前肥胖症医疗管理方法，以及对旨在辅助在医疗点对肥胖者、有肥胖风险者或糖尿病患者进行医疗管理的CMDS的需求。
采用一般归纳法，本定性研究以解释性认识论为指导。该方法包括对来自大学社区健康诊所的初级保健提供者（PCP）进行半结构化深度访谈。文献为访谈方案提供了参考，其中包括关于PCP的经验以及对改善其管理和预防超重及肥胖并发症能力的工具的需求的问题。
PCP（n = 10）描述了他们当前的方法，并强调饮食、体育活动和行为疗法相结合的行为治疗是超重或肥胖者的一线治疗方法。结果表明，CDSS的有益特征包括：（1）临床相关且可定制的支持；（2）提供带有趋势的全面医疗总结；（3）提供患者教育材料和社区资源；（4）简单且易于操作。
通过CDSS实施CMDS可以使PCP进行全面的心脏代谢疾病风险评估，支持对超重、肥胖和糖尿病的临床管理。本研究结果通过确定设计优化、改善最终用户体验以及成功采用CDSS的领域，为开发者和研究人员提供了独特见解。
