An Assessment of Weight Loss Management in Health System Primary Care Practices.
An Assessment of Weight Loss Management in Health System Primary Care Practices.
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DOI：
10.3122/jabfm.2022.220224r1
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发表时间：
2023-02-08
影响因子：
2.9
通讯作者：
Holtrop, Jodi Summers
中科院分区：
文献类型：
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作者：
Suresh, Krithika;Willems, Emileigh;Williams, Johnny, II;Gritz, R. Mark;Dickinson, L. Miriam;Perreault, Leigh;Holtrop, Jodi Summers
初级保健实践可以帮助患者通过减肥来解决肥胖问题，然而，这样做存在许多障碍。这项研究探讨了提供的体重管理服务和与更高的报告提供的服务相关的因素。对科罗拉多州卫生系统18个初级保健实践中的实践成员进行了调查。该调查评估了体重管理服务，以确定所提供的减肥帮助的数量和类型以及其他可能重要的因素。我们使用描述性统计来总结响应和线性回归与广义估计方程，以评估实践和实践成员特征与提供的体重管理服务量之间的关联。总有效率为65%（257/397）。平均而言，临床医生报告执行了70%的服务，当分为最小，基本和广泛时，临床医生平均分别执行了87%，78%和69%。在根据人口统计学调整的多变量模型中，与提供更多服务相关的因素包括对整体更好实践文化的感知（更多团队精神，更少混乱，更好的变革文化）（p=0.004）和对体重管理实施气候的感知（支持，认可和期望支持减肥）（p=0.07）。在双变量分析不相关的是实践水平的措施和临床医生的具体分数的工作满意度，满意度和适当的实践提供减肥服务的评估。与实践相关的因素，如文化和实施气候可能值得研究，以了解如何在初级保健中实施体重管理。
Primary care practices can help patients address obesity through weight loss, however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services. A survey was given to practice members in 18 primary care practices in a Colorado-based health system. The survey assessed weight management services to determine the amount and type of weight loss assistance provided and other factors that may be important. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between the practice and practice member characteristics and the amount of weight management services provided. The overall response rate was 65% (257/397). On average, clinicians reported performing 70% of the services, and when grouped into minimal, basic, and extensive, the clinicians on average performed 87%, 78%, and 69% of them respectively. In a multivariable model adjusted for demographics, factors associated with performing more services included perception of overall better practice culture (more team-ness, less chaos, better change culture) (p=0.004) and perception of weight management implementation climate (support for, recognition and expectation to support weight loss) (p=0.07). Not associated in bivariate analyses were practice-level measures and clinician-specific scores for work satisfaction, and satisfaction with and assessment of appropriateness for practice provision of weight loss services. Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.