A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals.
A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals.
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学前肥胖治疗临床试验：初级保健提供者拒绝转诊的原因。
DOI：
10.1016/j.jpeds.2016.06.027
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Stark,LoriJ
中科院分区：
文献类型：
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作者：
Robson,ShannonM;Bolling,Christopher;McCullough,MaryBeth;Stough,CathleenOdar;Stark,LoriJ
目的 通过随机临床试验 (RCT) 检查初级保健提供者 (PCP) 将学龄前肥胖儿童（体重指数 [BMI] ≥ 95%）转介至体重管理干预措施，并找出不转介儿童的原因。研究设计在第一阶段，3 位肥胖、心理学和营养专家完成了开放式卡片分类，并根据原因的相似性将 PCP 拒绝转诊的原因分类为不同组。然后定义并标记类别。在第二阶段，2 个独立的分类员将每次拒绝归入第一阶段定义的类别中。结果PCP 将 78% 的符合条件的儿童转介给 RCT。与拒绝转诊的儿童相比，转诊儿童的体重（48.4 磅 vs 46.1lb；P<0.001）和 BMI 百分位数显着更高（97.6 vs 97.0；P<0.001）。在第一阶段确定了 11 个下降类别。在第二阶段，每个独立分选机与第一阶段类别之间以及 2 个独立分选机之间都获得了出色的可靠性（κ 值，0.72-1.0）。拒绝的最常见原因是“家人不合适”（23.6%），其次是“不认为体重是一个问题”（13.9%）、“家人不会感兴趣”（12%）和“不相信测量结果准确”（11.5%）。相应地，随机对照试验的排除标准也是一个原因（11.8%）。结论通过随机对照试验对学龄前儿童进行体重管理似乎克服了先前研究中引用的资源、时间和可靠治疗的障碍。然而，对家庭反应或对体重管理计划的兴趣的担忧仍然是障碍，PCP 对幼儿肥胖的看法也是如此。试验注册ClinicalTrials.gov：NCT01546727。
ObjectiveTo examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children.Study designIn phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I.ResultsPCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb;P< .001) and BMI percentile (97.6 vs 97.0;P< .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was “family not a good fit” (23.6%), followed by “doesn't believe weight is a problem” (13.9%), “family would not be interested” (12%), and “doesn't believe measurement is accurate” (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%).ConclusionThe availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children.Trial registrationClinicalTrials.gov: NCT01546727.