Insights from the POWER Practice-Based Weight Loss Trial: A Focus Group Study on the PCP’s Role in Weight Management
- 614 Downloads
Despite U.S. Preventive Services Task Force recommendations, few primary care providers (PCPs) counsel obese patients about weight loss. The POWER practice-based weight loss trial used health coaches to provide weight loss counseling, but PCPs referred their patients and reviewed their patients’ progress reports. This trial provided a unique opportunity to understand PCPs’ actual and desired roles in a multi-component weight loss intervention.
1) To explore the PCP role, inclusive of and beyond the trial’s intended role, in a practice-based weight loss trial; and 2) to elicit recommendations by PCPs for wider dissemination of the successful multi-component program.
Qualitative focus group study of PCPs with ≥ 4 patients enrolled in trial.
Twenty-six out of 30 PCPs from six community practices participated between June and August 2010.
We used a semi-structured moderator guide. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded transcripts for thematic content, identified meaningful segments within the responses and assigned codes using an editing style analysis. Atlas.ti software was used for organization/analysis.
We identified five major themes related to the PCP’s role in patients’ weight management: (1) refer patients into program, provide endorsement; (2) provide accountability for patients; (3) “cheerlead” for patients during visits; (4) have limited role in weight management; and (5) maintain the long-term trusting relationship through the ups and downs. PCPs provided several recommendations for wider dissemination of the program into primary care practices, highlighting the need for specific feedback from coaches as well as efficient, integrated processes.
Weight loss programs have the potential to partner with PCPs to build upon the patient–provider relationship to improve patient accountability and sustain behavior change. However, rather than directing the weight loss, PCPs preferred a peripheral role by utilizing health coaches.
KEY WORDSqualitative research obesity primary care provider
This work was supported with a grant from the Johns Hopkins University Osler Center for Clinical Excellence at Johns Hopkins. POWER Hopkins was supported by a grant from the National Heart, Lung and Blood Institute (5U01HL087085-05). The original trial’s clinical trials.gov registration number was NCT00783315. Dr. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute, 5K23HL098476– 02.
The original trial involved a collaboration with Healthways, Inc., a disease management company. Healthways provided coaching effort for the transtelephonic intervention and developed the website used in the intervention. Healthways provided some research funding to supplement NIH support. Under an institutional consulting agreement with Healthways, the Johns Hopkins University received fees for advisory services to Healthways during the POWER trial. Faculty members who participated in the consulting services received a portion of the University fees.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 5.Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2012;157(5):373-8.Google Scholar
- 12.The Centers for Medicare and Medicaid Services (CMS). Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N) Intensive Behavioral Therapy for Obesity (CAG-00423N). http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253. Accessed 7/12/13.
- 18.Crabtree BF, Miller WL. Doing qualitative research. Newbury Park: Sage Publications; 1992:276.Google Scholar
- 19.Ockene IS, Hebert JR, Ockene JK, et al. Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester area trial for counseling in hyperlipidemia (WATCH). Arch Intern Med. 1999;159(7):725–31.PubMedCrossRefGoogle Scholar
- 22.Carvajal R, Wadden TA, Tsai AG, Peck K, Moran CH. Managing obesity in primary care practice: a narrative review. Ann N Y Acad Sci. 2013;1281:191-206.Google Scholar
- 27.Tang JW, Kushner RF, Cameron KA, Hicks B, Cooper AJ, Baker DW. Electronic tools to assist with identification and counseling for overweight patients: a randomized controlled trial. J Gen Intern Med. 2012;27(8):933-9.Google Scholar