Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.
Ann Fam Med. 2023 May-Jun;21(3):249-255. doi: 10.1370/afm.2966.
To describe the characteristics of patients and practice of clinicians during standard-of-care for weight management in a large, multiclinic health system before the implementation of PATHWEIGH, a pragmatic weight management intervention.
We analyzed baseline characteristics of patients, clinicians, and clinics during standard-of-care for weight management before the implementation of PATHWEIGH, which will be evaluated for effectiveness and implementation in primary care using an effectiveness-implementation hybrid type-1 cluster randomized stepped-wedge clinical trial design. A total of 57 primary care clinics were enrolled and randomized to 3 sequences. Patients included in the analysis met the eligibility requirements of age ≥18 years and body mass index (BMI) ≥25 kg/m and had a weight-prioritized visit (defined a priori) during the period March 17, 2020 to March 16, 2021.
A total of 12% of patients aged ≥18 years and with a BMI ≥25 kg/m seen in the 57 practices during the baseline period (n = 20,383) had a weight-prioritized visit. The 3 randomization sequences of 20, 18, and 19 sites were similar, with an overall mean patient age of 52 (SD 16) years, 58% women, 76% non-Hispanic White patients, 64% with commercial insurance, and with a mean BMI of 37 (SD 7) kg/m. Documented referral for anything weight related was low (<6%), and 334 prescriptions of an antiobesity drug were noted.
Of patients aged ≥18 years and with a BMI ≥25 kg/m in a large health system, 12% had a weight-prioritized visit during the baseline period. Despite most patients being commercially insured, referral to any weight-related service or prescription of antiobesity drug was uncommon. These results fortify the rationale for trying to improve weight management in primary care.
在实施实用体重管理干预措施 PATHWEIGH 之前，描述在大型多诊所医疗系统中标准体重管理护理下患者的特征和临床医生的实践情况。
我们分析了 PATHWEIGH 实施前标准体重管理护理期间患者、临床医生和诊所的基线特征，将使用有效性-实施混合 1 型聚类随机阶梯式临床试验设计评估其在初级保健中的效果和实施情况。共纳入 57 家初级保健诊所，并按 3 个序列进行随机分组。符合纳入标准的患者年龄≥18 岁，体重指数（BMI）≥25kg/m²，并在 2020 年 3 月 17 日至 2021 年 3 月 16 日期间进行了以体重为重点的就诊（预先定义）。
在基线期 57 家诊所中，年龄≥18 岁且 BMI≥25kg/m²的患者中，有 12%（n=20383）进行了以体重为重点的就诊。20、18 和 19 个站点的 3 个随机序列相似，总体患者平均年龄为 52（SD 16）岁，58%为女性，76%为非西班牙裔白人患者，64%有商业保险，平均 BMI 为 37（SD 7）kg/m²。记录的任何与体重相关的转诊都很少（<6%），共开具了 334 份抗肥胖药物处方。
在大型医疗系统中，年龄≥18 岁且 BMI≥25kg/m²的患者中，有 12%在基线期进行了以体重为重点的就诊。尽管大多数患者有商业保险，但很少有患者转诊到任何与体重相关的服务或开具抗肥胖药物处方。这些结果为尝试改善初级保健中的体重管理提供了依据。
