Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States.
School of Medicine, University of Missouri, Columbia, Missouri, United States.
Appl Clin Inform. 2024 Mar;15(2):368-377. doi: 10.1055/a-2283-9036. Epub 2024 Mar 8.
Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input.
We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers.
In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians ( = 52) at two private and two academic health centers in Missouri.
Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data.
Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
临床医生在解决儿科和青少年肥胖问题方面发挥着重要作用，但他们的有效性受到时间限制、竞争临床需求以及缺乏有效电子健康记录 (EHR) 工具的限制。EHR 工具很少在有提供者投入的情况下开发。
我们对为儿童和青少年提供体重管理护理的临床医生进行了一项混合方法研究，以确定有效护理的当前障碍，并探讨 EHR 体重管理工具在克服这些障碍中的作用。
在这项混合方法研究中，我们在密苏里州的一家中型学术医疗中心进行了三次 1 小时长的虚拟焦点小组讨论，并使用主题分析对焦点小组脚本进行了分析。我们还对密苏里州两家私立和两家学术医疗中心的儿科和家庭医学初级保健临床医生（ = 52）进行了电子邮件调查，并对调查进行了描述性统计分析。
接受调查的临床医生报告说，他们在常规儿童保健就诊（范围为 1-100 的平均值为 60）和儿童肥胖就诊（63）时有效地提供了健康行为生活方式咨询；然而，大多数人认为当前的医疗保健系统（27）和 EHR 工具（41）不能充分支持儿科体重管理。临床医生焦点小组的主要主题是 EHR 体重管理工具应以下列方式显示数据：（1）提高临床效率，（2）支持以患者为中心的沟通，（3）改善就诊期间的患者连续性，（4）减轻文档负担。另一个主题是（5）临床医生信任实时输入的患者数据而不是患者回忆的数据。
研究参与者报告说，医疗保健系统现状和现有的 EHR 工具不足以支持努力管理儿科或青少年肥胖并提供健康行为咨询的临床医生。EHR 体重管理工具的临床医生投入为解决障碍、提供内容和提高 EHR 使用效率提供了机会。
