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基层医疗中记录的超重/肥胖诊断与肥胖护理执行率相关。

Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates.

作者信息

Shalitin Shlomit, Phillip Moshe, Yackobovitch-Gavan Michal

机构信息

The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

出版信息

Pediatr Res. 2025 Apr;97(5):1554-1565. doi: 10.1038/s41390-024-03619-0. Epub 2024 Oct 8.

Abstract

BACKGROUND

Periodical BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. The aim was to evaluate among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care.

METHODS

The electronic database of the largest health maintenance organization in Israel was searched for all patients aged 2-18 years with BMI recorded at a visit with the PCP during 2017-2023. Among children with BMI percentiles consistent with overweight/obesity, performance rates of obesity care were compared between those with a recorded diagnosis of "overweight"/"obesity" placed by the PCP, and those with similar BMI percentiles without these recorded diagnoses.

RESULTS

Among children with versus without recorded diagnoses of overweight/ obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, of performing subsequent BMI measurements, and of prescribing anti-obesity medications (p < 0.001 for all). Obesity-related comorbidities were more prevalent among those with than without recorded diagnoses (P < 0.001).

CONCLUSIONS

Beyond BMI measurement, a recorded diagnosis of overweight/obesity by a PCP is linked to higher rates of obesity care performance and interventions, which may improve clinical outcomes.

IMPACT STATEMENT

BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. We evaluated among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care. We found that among children with versus without recorded diagnoses of overweight/obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, and of prescribing anti-obesity medications. Therefore, PCP should increase rates of recording diagnoses of overweight/obesity, to promote screening for obesity-related comorbidities, and aim to treat obesity as a chronic disease.

摘要

背景

在初级保健儿科医生(PCP)问诊期间定期测量体重指数(BMI)对于超重/肥胖的诊断、管理和治疗至关重要。目的是评估在BMI百分位数相似的儿童和青少年中,PCP记录超重/肥胖的正式诊断是否与肥胖相关护理的执行率提高有关。

方法

在以色列最大的健康维护组织的电子数据库中搜索2017年至2023年期间在PCP问诊时记录了BMI的所有2至18岁患者。在BMI百分位数与超重/肥胖一致的儿童中,比较PCP记录了“超重”/“肥胖”诊断的儿童与BMI百分位数相似但无这些记录诊断的儿童的肥胖护理执行率。

结果

在有与没有记录超重/肥胖诊断的儿童中,转诊进行肥胖相关合并症筛查测量、营养师和内分泌咨询、后续BMI测量以及开具抗肥胖药物的比例更高(所有p值均<0.001)。有记录诊断的儿童中肥胖相关合并症比无记录诊断的儿童更普遍(P<0.001)。

结论

除了BMI测量外,PCP记录的超重/肥胖诊断与更高的肥胖护理执行率和干预措施相关,这可能改善临床结果。

影响声明

在初级保健儿科医生(PCP)问诊期间测量BMI对于超重/肥胖的诊断、管理和治疗至关重要。我们评估了在BMI百分位数相似的儿童和青少年中,PCP记录超重/肥胖的正式诊断是否与肥胖相关护理的执行率提高有关。我们发现,在有与没有记录超重/肥胖诊断的儿童中,转诊进行肥胖相关合并症筛查测量、营养师和内分泌咨询以及开具抗肥胖药物的比例更高。因此,PCP应提高记录超重/肥胖诊断的比例,以促进肥胖相关合并症的筛查,并将肥胖作为慢性病进行治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bed9/12119345/141ea2ca44ab/41390_2024_3619_Fig1_HTML.jpg

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