Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial
- 339 Downloads
Physicians often do not recognize when their patients are overweight and infrequently counsel them about weight loss.
To evaluate a set of electronic health record (EHR)-embedded tools to assist with identification and counseling of overweight patients.
Randomized controlled trial.
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.
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.
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.
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.
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 WORDSoverweight counseling electronic health record
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.
- 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