Abstract

1. An Intervention to Help Practitioners Address Overweight/Obese Pediatric PatientsAllen G. Strickler PhD1, Susan B. Cluett CRNP,2 Angela J. Hasemann RD2, Mark D. DeBoer MD21The University of Virginia School of Medicine/Department of Public Health Sciences, 2The University of Virginia Department of Pediatrics Abstract Results There is an alarming trend in the increase of United States children and adolescents who are overweight/obese. We believe practice gaps exist in the patient/health care provider relationship, which contribute to the problem. We are developing a continuing medical education module and online toolkit to help health care providers better manage overweight/obese pediatric patients. To assist us in development of these learning materials, we administered a survey questionnaire to health care providers in the catchment area of the Children’s Fitness Clinic of the University of Virginia Health System to determine their knowledge and practices. The typical respondent was a Pediatrician who sees patients for 21 to 40 hours a week and has been practicing between 11 and 20 years. They only sometimes referred to other sources for care and feel somewhat confident in managing comorbidities. The majority knew of the Children’s Fitness Clinic and felt it was a valuable resource, but were unsure of the success of their referred patients. Based on these results, we will target our learning materials to address areas of overweight/obese child identification, management of comorbidities, referral practices, and evaluation methods. By performing a needs assessment via the survey questionnaire, we effectively targeted gaps in health care provider knowledge and practices. This approach will help us develop effective learning materials to institute change in physician practices so they can successfully address pediatric overweight/obesity. Questionnaire completion rates were 18/62 (29%) for the electronic version and 52/248 (21%) for the mailed paper version. The overall completion rate was 70/310 (23%) . The questionnaire responses most pertinent to developing the learning materials are summarized below. Table 2: Responses to Questions Pertaining to HCP Characteristics Figure 1: Frequency of BMI Checks. The graph shows the percent respondents by specialty (and overall respondents) broken down into how often BMI checks are performed on pediatric patients in their practices. Total respondents by category is shown in the legend. 70 41 19 10 Table 3: Responses to Questions Pertaining to HCP Practices 70 41 19 10 Introduction Figure 2: Confidence in Managing Psychosocial Factors. The graph shows the percent respondents by specialty (and overall respondents) broken down into their confidence in managing Non-Alcoholic Fatty Liver Disease (NAFLD) and Psychosocial Factors.Total respondents by category is shown in the legend. The pediatric obesity epidemic has become a significant problem facing the health care system and society as a whole. Recent statistics indicate that children aged 2 to 5 and those aged 6 to 11 have obesity rates of 10% and 15% respectively1. Adolescent obesity rates have increased by over 13% during the time time period of 1980 to 2008.2 Obesity causes numerous health and psychosocial comorbidities, which are outlined in Table 1. It is important to identify causes of pediatric obesity and address them in an efficient manner to help prevent these health problems. The patient/Health Care Provider (HCP) encounter presents a unique opportunity to address an individual’s obesity issues. We believe practice gaps that occur during these encounters serve as a barrier to providing patients with the opportunity or impetus to make health lifestyle changes. The Children’s Fitness Clinic (CFC) at the University of Virginia serves as a referral resource to help pediatric obesity patients make these changes. However, we feel that HCP’s can make improvements in their own patient identification, management, referral, and evaluation practices to help address the issue. Our goal is to develop a CME module and an online toolkit to help HCPs improve in these areas. To aid in the development of these learning materials, we administered a survey questionnaire to HCPs in the catchment area of the CFC to identify practice gaps. The results will help us appropriately develop these learning materials. Table 4: Responses to Questions Specific to the CFC Conclusions & Future Work • Our main HCP demographic is Pediatricians who have been in practice 11 to 20 years. • HCPs were mostly aware of the CFC and sometimes referred patients • Travel distance, follow up, and convincing patients to go to the CFC serve as major treatment barriers. • Not all HCPs are checking BMIs as often as recommended and the majority feel only somewhat confident in managing obesity comorbidities. • We will address these points and others in our learning materials. • We will also develop defined metrics of patient success. • We will perform a second survey and a chart review to gauge the success of our learning materials. Table 5: Common Response Themes to the Open Ended Question Table 1: Examples of Pediatric Obesity Comorbidities Methods • We developed a 24 item survey questionnaire that was administered to HCP’s in the CFC catchment area. An electronic version developed in QuestionPro was sent to 64 HCPs for whom we had email addresses. A paper copy was sent to an additional 248 HCPs. • Questions included categories of HCP characteristics, HCP practices, CFC specific questions, and an open-ended question. • The responses from the returned paper questionnaires were entered into QuestionPro. All data were subsequently analyzed in QuestionPro using real time summary and cross tabulation functions. References: 1. Kyung E. Rhee et al., “Factors Associated With Parental Readiness to Make Changes for Overweight Children,”Pediatrics 116, no. 1 (July 1, 2005): e94-101. 2. www.cdc.gov Presented at the 2011 Virginia Association for Public Health Meeting