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Capstone

Does an educational binder on weight management placed in clinic exam rooms increase the likelihood that weight managemtent will be addressed by primary care providers?

1 August 2006

Abstract

Background: Overweight and obesity are a growing epidemic in the United States for adults, adolescents and children. Minorities, such as the Mexican-American population and those who are of lower socioeconomic class are also more likely to be overweight and/or obese. Obesity is associated with disease states such as type II diabetes mellitus, hypertension and osteoarthritis. Primary care providers are in the frontline to addressing weight management and aiding in its prevention, management and treatment. There are multiple barriers that exist for providers which make it difficult to discuss weight management, such as lack of time, perceived patient noncompliance and inadequate teaching materials.

Objective: To assess whether or not a healthy weight management educational tool, in the form of a binder, placed in the clinic exam rooms of a community health clinic will increase the likelihood that clinicians and their patients will discuss weight management.

Design: This is a single-group, pre-and post- survey design.

Setting: La CIinica del Carino, a single community health center, with sites in both Hood River, Oregon and The Dalles, Oregon. Subjects: Eleven primary care clinicians currently employed at La Clfnica del Carino.

Results: Before the binder was placed in the clinic exam rooms, the clinicians discussed weight management with their patients, on average, 33% of the total visits. After the binder was in the clinic exam room for 2 weeks, the clinicians discussed weight management, on average, 37% of the total visits. The p-value was < 0.05. Clinicians initiated the discussion on weight management pre-binder, on average, 78% of the time. Post-binder, clinicians initiated the discussion on weight management, on average, 62% of the time. This was a significant decrease with a p-value of < 0.01. Pre-binder, patients initiated the discussion on weight management, on average, 23% of the time. Post-binder, patients initiated the discussion on weight management, on average, 31 % of the time. This was a significant increase with a p-value of < 0.01. Paired ttests did not show a significant difference for each individual clinician on frequency of discussion pre and post-binder or on differences pre and post-binder for initiation of conversation by clinician or patient.

Conclusions: Intervention tools, such as the weight management binder, can act as a mediator and provide "talking points" between the clinician and patient. Our study reflected that such a tool, with its mere presence in the clinic room, can lead to increased discussion regarding weight management. It also demonstrated that even though each individual clinician did not experience an increase in discussion, at least a portion of them were influenced and the topic was discussed more frequently. Even this improvement is a significant step in the right direction. It is possible that such intervention tools can be implemented in many primary care clinics as an aid to the prevention, management and treatment of overweight and obesity. Follow-up studies in the future will reveal if the binders have a long-tern effect on the number of discussions between providers and their patients on healthy weight management.


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