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尽管使用了电子健康记录,但儿童肥胖的诊断和管理仍然是一项挑战:一项回顾性研究。

Childhood obesity diagnosis and management remains a challenge despite the use of electronic health records: A retrospective study.

作者信息

Paquette Jean-Sébastien, Théorêt Laurence, Veilleux Laurence, Graham Johann, Paradis Marie-Pier, Chamberland Nathalie, Lanctôt Gabrielle, Breault Pascale, Pelletier Mathieu, Boudreault Samuel

机构信息

ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS Lanaudière Joliette Quebec Canada.

Départment de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine Université Laval Quebec City Quebec Canada.

出版信息

Health Sci Rep. 2022 Aug 8;5(5):e763. doi: 10.1002/hsr2.763. eCollection 2022 Sep.

Abstract

BACKGROUND

The use of electronic health records (EHR) has revolutionized medical practice by improving the quality of care. Childhood obesity (CO) increases the risk of developing other chronic diseases and has a serious psychosocial impact on children. Using EHR may improve this clinical condition since early diagnosis is a crucial means of preventing its negative impacts.

OBJECTIVES

The aim of the study was to assess the diagnosis and management of CO in a Canadian academic family medicine group unit (FMG-U) that uses EHR with an integrated CO diagnosis tool.

METHODS

This is a retrospective study conducted in an FMG-U in the province of Quebec. The clinical practice guidelines established by the World Health Organization (WHO) were used to assess diagnosis and management of CO. EHR of every patient from 5 to 12 years old who had a medical appointment at the FMG-U in 2017 ( = 618) were analyzed. EHR use by clinicians was assessed by a closed-ended online survey sent to clinicians who provided pediatric care at that clinic in 2017.

RESULTS

We identified 69 patients as obese according to the WHO, of whom 40 had been diagnosed by health professionals at the clinic. Of these, 33 received nutritional counseling; 33 received physical activity counseling; 13 received parent involvement counseling; 19 were referred to another health professional; and 12 were followed up within 6 months. Ten out of 15 clinicians responded to the survey. They all used the EHR integrated CO diagnosis tool but only 20% were truly familiar with it.

CONCLUSIONS

This study shows that CO is still underdiagnosed in primary care, notwithstanding the use of EHR with integrated tools. This affects the quality of care. Moreover, even if CO were correctly diagnosed, its management remains incomplete. Knowledge translation by medical organizations plays an important role in addressing this problem.

摘要

背景

电子健康记录(EHR)的使用通过提高医疗质量彻底改变了医疗实践。儿童肥胖(CO)会增加患其他慢性病的风险,并对儿童产生严重的心理社会影响。使用电子健康记录可能会改善这种临床状况,因为早期诊断是预防其负面影响的关键手段。

目的

本研究的目的是评估在一个使用带有综合CO诊断工具的电子健康记录的加拿大学术家庭医学组单位(FMG-U)中CO的诊断和管理情况。

方法

这是一项在魁北克省的一个FMG-U中进行的回顾性研究。采用世界卫生组织(WHO)制定的临床实践指南来评估CO的诊断和管理。分析了2017年在FMG-U就诊的所有5至12岁患者(n = 618)的电子健康记录。通过向2017年在该诊所提供儿科护理的临床医生发送的封闭式在线调查来评估临床医生对电子健康记录的使用情况。

结果

根据WHO标准,我们确定了69名肥胖患者,其中40名已被诊所的卫生专业人员诊断。在这些患者中,33名接受了营养咨询;33名接受了体育活动咨询;13名接受了家长参与咨询;19名被转介给另一名卫生专业人员;12名在6个月内接受了随访。15名临床医生中有10名回复了调查。他们都使用了电子健康记录综合CO诊断工具,但只有20%的人真正熟悉它。

结论

本研究表明,尽管使用了带有综合工具的电子健康记录,但在初级保健中CO仍未得到充分诊断。这影响了医疗质量。此外,即使CO被正确诊断,其管理仍然不完整。医疗组织的知识转化在解决这个问题中起着重要作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/573c/9358539/c288eef5d61a/HSR2-5-e763-g001.jpg

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