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Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial

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Abstract

Background

Physicians often do not recognize when their patients are overweight and infrequently counsel them about weight loss.

Objective

To evaluate a set of electronic health record (EHR)-embedded tools to assist with identification and counseling of overweight patients.

Design

Randomized controlled trial.

Participants

Physicians at an academic general internal medicine clinic were randomized to activation of the EHR tools (n = 15) or to usual care (n = 15). Patients of these physicians were included in analyses if they had a body mass index (BMI) between 27 and 29.9 kg/m2.

Intervention

The EHR tool set included: a physician point-of-care alert for overweight (BMI 27–29. 9 kg/m2); a counseling template to help physicians counsel patients on action plans; and an order set to facilitate entry of overweight as a diagnosis and to order relevant patient handouts.

Main Measures

Physician documentation of overweight as a problem; documentation of weight-specific counseling; physician perceptions of the EHR tools; patient self-reported progress toward their goals and perspectives about counseling received.

Key Results

Patients of physicians receiving the intervention were more likely than those of usual care physicians to receive a diagnosis of overweight (22% vs. 7%; p = 0.02) and weight-specific counseling (27% vs. 15%; p = 0.02). Most patients receiving counseling in the intervention group reported increased motivation to lose weight (90%) and taking steps toward their goal (93%). Most intervention physicians agreed that the tool alerted them to patients they did not realize were overweight (91%) and improved the effectiveness of their counseling (82%); more than half (55%) reported counseling overweight patients more frequently (55%). However, most physicians used the tool infrequently because of time barriers.

Conclusions

EHR-based alerts and management tools increased documentation of overweight and counseling frequency; the majority of patients for whom the tools were used reported short-term behavior change.

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Acknowledgements

Dr. Tang was supported by an institutional award from the Agency for Health care Research and Quality, T-32 HS 000078 training grant. These results were previously presented at the 2011 SGIM National Meeting in Phoenix, AZ, for which the abstract was selected as a finalist for the Mack Lipkin Sr. Associate Member Award.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 9th floor, Chicago, IL, 60611, USA

    Joyce W. Tang MD, Robert F. Kushner MD, Kenzie A. Cameron PhD, MPH, Andrew J. Cooper MPH & David W. Baker MD, MPH

  2. Clinical Information Technology Solutions, Cleveland Clinic, Cleveland, OH, USA

    Brent Hicks BEd

Authors
  1. Joyce W. Tang MD
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  2. Robert F. Kushner MD
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  3. Kenzie A. Cameron PhD, MPH
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  5. Andrew J. Cooper MPH
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  6. David W. Baker MD, MPH
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Corresponding author

Correspondence to Joyce W. Tang MD.

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Tang, J.W., Kushner, R.F., Cameron, K.A. et al. Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial. J GEN INTERN MED 27, 933–939 (2012). https://doi.org/10.1007/s11606-012-2022-8

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  • DOI: https://doi.org/10.1007/s11606-012-2022-8

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