JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
to. By submitting this survey, you provide your consent for our research team to review and use the information you share with us. Your responses will be kept confidential.”
(4%), and a clinical psychologist also provided information. The types of physicians represented included pediatricians, pediatric subspecialists (endocrinologists and a gastroenterologist), combined internists/pediatricians, and family practitioners.
Description of Survey and Procedures
Providers’ Screening and Treatment Practices
The survey consisted of 26 multiple-choice and open-ended questions pertaining to the provider’s current practices in childhood obesity and T2DM screening and the pediatric weight management services offered at the provider’s facility. The USPSTF guidelines included: 1) screen for obesity if age ≥ 6 y; 2) if obese, refer to intervention; 3) offer obesity intervention with diet, physical activity, and behavioral counseling; 4) offer intervention lasting ≥ 6 months; and 5) offer intervention consisting of > 25 contact hours. The guidelines for T2D screening included: 1) screen for T2DM and 2) T2DM screening includes hemoglobin A1c or glucose. 10,11 The survey also queried the provider’s medical specialty and clinic location. Surveys were hand delivered, emailed, mailed, and/or faxed to recipients over a 6-month period (i.e. January to June 2015). An open-access link to the survey was listed on a website that targeted primary care providers. The online version of the survey was deployed by the Research Electronic Data Capture (REDCap) website hosted at Pennington Biomedical Research Center. Designed byVanderbilt University, REDCap uses a secure, web-based application to collect and store data for research purposes. 12 Alternatively, providers could complete a hard copy and return the survey via fax, mail, or email. Hard-copy surveys that were mailed or hand-delivered were entered into REDCap by a research assistant. Participants were informed that their responses would be used for research purposes. Providers could choose to provide personal contact information or complete the survey anonymously. Study procedures and materials were approved by the Pennington Biomedical Research Center Institutional Review Board.
The providers’ screening and obesity treatment practices are displayed in Table 1. The majority (88%) of providers reported screening for obesity via calculating body mass index (BMI) as a part of a regular child visit, and 61% used electronic medical records (EMRs) to automatically calculate BMI. Most providers (67%) indicated using multiple ICD-9 codes to bill for childhood obesity screening and treatment services. Sixty-three percent of providers reported screening for T2DM, and the most commonly used tools were hemoglobin A1c, fasting plasma glucose, and overweight/obesity.
WEIGHT MANAGEMENT SERVICES
Referral to Services
Though most providers estimated that between 20 and 39% of their pediatric patients were overweight/obese (Figure 1A), few referred children who were overweight or obese to a weight management service (Figure 1B). The majority (59%) of the providers indicated an increase in number of pediatric patients with overweight/obesity in the last 5 years, while 30% reported the number had not changed.
Provision of Services
Weight management services were provided by various departments within the providers’ facilities, including general pediatrics, nutrition, gastroenterology, and endocrinology. Fifty-five percent reported treatment delivered by multiple departments within the same facility. Out of the 31 providers who offered obesity treatment, most offered Stage 1 or 2 but few offered Stage 3 or 4 (Table 1). Among the healthcare providers and/or facilities who directly provided any weight intervention component, 64% provided multiple types of services, most commonly nutrition therapy, medical monitoring or assessment, and exercise services. Of six who prescribed medication as an additional treatment for pediatric obesity, three offered Metformin. Other prescriptions included appetite stimulants/depressants, Adderall, and Xenical/Orlistat. Two providers reported prescribing multiple medications. Thirty-three percent of the responding providers’ facilities offered multiple stages of treatment.
Data Analysis
Of the 70 providers, 13 were excluded from the analysis due to answering only one question. Fifty-seven surveys were included in the analysis. The primary endpoints were summary data of the screening and treatment practices currently offered by providers. The secondary endpoints were proportion of providers who provided screening and treatment services that met each of seven identified clinical guidelines.
RESULTS
Survey Participants
Eligibility for Services
The 57 providers were located in 17 cities across Louisiana. The majority practiced in primary care (56%) or specialty (18%) clinics. Others worked in hospitals, school health centers, a federally qualified health center, or a mobile medical unit. Most of the providers identified as physicians (75%), though nurses/ nurse practitioners (9%), dietitians (5%), exercise physiologists
To determine inclusion of children into the weight management programs, most providers used the 85th percentile (overweight) or 95th percentile (obesity) as the threshold. Twenty-four percent of the providers offered their weight management services to children as young as 5 years, and 8% to infants (0-1 years) if needed. Fifty-six percent of the providers provided these
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