Journal of General Internal Medicine

, Volume 27, Issue 8, pp 933–939 | Cite as

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

  • Joyce W. Tang
  • Robert F. Kushner
  • Kenzie A. Cameron
  • Brent Hicks
  • Andrew J. Cooper
  • David W. Baker
Original Research

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.

KEY WORDS

overweight counseling electronic health record 

Notes

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.

References

  1. 1.
    McTigue KM, Garrett JM, Popkin BM. The natural history of the development of obesity in a cohort of young U.S. adults between 1981 and 1998. Ann Intern Med. 2002;136(12):857–64.PubMedGoogle Scholar
  2. 2.
    McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139(11):933–49.PubMedGoogle Scholar
  3. 3.
    Vasan RS, Pencina MJ, Cobain M, Freiberg MS, D'Agostino RB. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med. 2005;143(7):473–80.PubMedGoogle Scholar
  4. 4.
    Chang VW, Christakis NA. Self-perception of weight appropriateness in the United States. Am J Prev Med. 2003;24(4):332–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK. Perceived health risk of excess body weight among overweight and obese men and women: differences by sex. Prev Med. 2008;47(1):46–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Post RE, Mainous AG 3rd, Gregorie SH, Knoll ME, Diaz VA, Saxena SK. The influence of physician acknowledgment of patients' weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med. 2011;171(4):316–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Rodondi N, Humair JP, Ghali WA, et al. Counselling overweight and obese patients in primary care: a prospective cohort study. Eur J Cardiovasc Prev Rehabil. 2006;13(2):222–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Tsai AG, Wadden TA. Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med. 2009;24(9):1073–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Ruser CB, Sanders L, Brescia GR, et al. Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med. 2005;20(12):1139–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Waring ME, Roberts MB, Parker DR, Eaton CB. Documentation and management of overweight and obesity in primary care. J Am Board Fam Med. 2009;22(5):544–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Milder IE, Blokstra A, de Groot J, van Dulmen S, Bemelmans WJ. Lifestyle counseling in hypertension-related visits–analysis of video-taped general practice visits. BMC Fam Pract. 2008;9:58.PubMedCrossRefGoogle Scholar
  12. 12.
    Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995;24(6):546–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Rattay KT, Ramakrishnan M, Atkinson A, Gilson M, Drayton V. Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics. 2009;123(Suppl 2):S100–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Krist AH, Woolf SH, Frazier CO, et al. An electronic linkage system for health behavior counseling effect on delivery of the 5A's. Am J Prev Med. 2008;35(5 Suppl):S350–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Flocke SA, Gilchrist V. Physician and patient gender concordance and the delivery of comprehensive clinical preventive services. Med Care. 2005;43(5):486–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Frank E, Segura C, Shen H, Oberg E. Predictors of Canadian physicians' prevention counseling practices. Can J Public Health.. 2010;101(5):390–5.PubMedGoogle Scholar
  17. 17.
    Lorig K. Action planning: a call to action. J Am Board Fam Med.. 2006;19(3):324–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Phelan S, Nallari M, Darroch FE, Wing RR. What do physicians recommend to their overweight and obese patients? J Am Board Fam Med. 2009;22(2):115–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Mehrotra A, Zaslavsky AM, Ayanian JZ. Preventive health examinations and preventive gynecological examinations in the United States. Arch Intern Med. 2007;167(17):1876–83.PubMedCrossRefGoogle Scholar
  21. 21.
    Chen LM, Farwell WR, Jha AK. Primary care visit duration and quality: does good care take longer? Arch Intern Med. 2009;169(20):1866–72.PubMedCrossRefGoogle Scholar
  22. 22.
    McAlpine DD, Wilson AR. Trends in obesity-related counseling in primary care: 1995-2004. Med Care. 2007;45(4):322–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen D, DiCicco-Bloom B, Strickland PO, et al. Opportunistic approaches for delivering preventive care in illness visits. Prev Med. 2004;38(5):565–73.PubMedCrossRefGoogle Scholar
  24. 24.
    Stange KC, Flocke SA, Goodwin MA. Opportunistic preventive services delivery. Are time limitations and patient satisfaction barriers? J Fam Pract. 1998;46(5):419–24.PubMedGoogle Scholar
  25. 25.
    Stange KC, Woolf SH, Gjeltema K. One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med. 2002;22(4):320–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Bodenheimer T. Helping patients improve their health-related behaviors: what system changes do we need? Dis Manag. 2005;8(5):319–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns. 2009;76(2):174–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Handley M, MacGregor K, Schillinger D, Sharifi C, Wong S, Bodenheimer T. Using action plans to help primary care patients adopt healthy behaviors: a descriptive study. J Am Board Fam Med. 2006;19(3):224–31.PubMedCrossRefGoogle Scholar
  29. 29.
    Jay M, Schlair S, Caldwell R, Kalet A, Sherman S, Gillespie C. From the patient's perspective: the impact of training on resident physician's obesity counseling. J Gen Intern Med. 2010;25(5):415–22Google Scholar
  30. 30.
    Ockene IS, Hebert JR, Ockene JK, Merriam PA, Hurley TG, Saperia GM. Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). Am J Prev Med. 1996;12(4):252–8.PubMedGoogle Scholar
  31. 31.
    Puczynski S, Phelps K, Wilke A. Collaborative goal setting to improve lifestyle behaviors: lessons learned from NOPCRN. Ann Fam Med. 2005;3 Suppl 2:S60–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Jha AK. Meaningful use of electronic health records: the road ahead. JAMA. 2010;304(15):1709–10.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Joyce W. Tang
    • 1
  • Robert F. Kushner
    • 1
  • Kenzie A. Cameron
    • 1
  • Brent Hicks
    • 2
  • Andrew J. Cooper
    • 1
  • David W. Baker
    • 1
  1. 1.Division of General Internal Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Clinical Information Technology SolutionsCleveland ClinicClevelandUSA

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