University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
UPMC Children's Community Pediatrics, Pittsburgh, Pennsylvania, USA.
Pediatr Obes. 2024 Aug;19(8):e13146. doi: 10.1111/ijpo.13146. Epub 2024 Jun 16.
Recent pediatric guidelines recommend clinicians offer anti-obesity medication (AOM) as an adjunct to intensive lifestyle intervention.
To investigate pediatricians' perspectives about prescribing AOM, including barriers and facilitators.
An investigator-developed survey was emailed to primary care pediatric physicians (n = 187) and advanced practice providers (n = 190) within an academic-affiliated network. The survey evaluated how willing clinicians were to prescribe AOM and their agreement with 25 statements about barriers and facilitators. Three vignettes explored AOM decision-making. Multinomial logistic regression was used to determine relative risk ratios for willingness to prescribe by agreement with each statement.
Among 74 respondents (20% response rate), 24% were willing, 42% uncertain and 34% unwilling to prescribe. Most (64%) agreed that AOM should be managed only by specialists. Willingness to prescribe was associated with clinician motivation and belief in guideline practicality and applicability. Unwillingness was associated with beliefs that patients would not continue AOM long enough for benefit and that there was insufficient time or resources to implement. In vignettes, 52% were willing to prescribe AOM for a patient with severe obesity and metabolic complications, versus 11% for a patient with obesity and possible disordered eating.
Willingness to prescribe AOM was low and was associated with perceived practicality and appropriateness for patients.
最近的儿科指南建议临床医生将抗肥胖药物（AOM）作为强化生活方式干预的辅助手段。
调查儿科医生对开处 AOM 的看法，包括障碍和促进因素。
一项由研究者开发的调查通过电子邮件发送给了一个学术附属网络中的初级保健儿科医生（n=187）和高级执业医师（n=190）。该调查评估了临床医生开处 AOM 的意愿，以及他们对 25 条关于障碍和促进因素的陈述的认同程度。三个案例探讨了 AOM 的决策过程。多变量逻辑回归用于确定对每个陈述的同意程度与开具 AOM 的意愿之间的相对风险比。
在 74 名受访者（20%的回应率）中，24%的人愿意开处方，42%的人不确定，34%的人不愿意开处方。大多数人（64%）认为 AOM 应由专家来管理。开处方的意愿与临床医生的动机以及对指南实用性和适用性的信念有关。不愿意开处方的原因是患者不太可能长期服用 AOM 以获得益处，而且实施的时间或资源不足。在案例中，52%的人愿意为有严重肥胖和代谢并发症的患者开 AOM，而只有 11%的人愿意为有肥胖和可能饮食失调的患者开 AOM。
开 AOM 的意愿较低，且与患者的实际情况和适用性有关。
