Providers as Weight Coaches: Using Practice Guides and Motivational Interview to Treat Obesity in the Pediatric Office

Tripp, Sandy Blizzard; Perry, Joan Templeton; Romney, Sharon; Blood‐Siegfried, Jane

doi:10.1016/j.pedn.2011.07.009

Cited by 32 publications

(31 citation statements)

References 11 publications

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“…5 The use of MI has expanded over the years from substance abuse to adherence to HAART and more recently to adherence to other chronic medications. [6][7][8] Most studies to date have focused on minority populations. A recent systematic review evaluated the impact of cognitive-based behavior change techniques on adherence 3 and found them to be superior to usual care; however, this review included multi-layer cognitive interventions and did no focus exclusively on MI.…”

Section: Introductionmentioning

confidence: 99%

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

et al. 2016

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BACKGROUND: Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. OBJECTIVES: To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. DATA SOURCES: We searched the MEDLINE database for studies published from 1966 until February 2015. STUDY ELIGIBILITY CRITERIA: We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. DATA SYNTHESIS: The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. RESULTS: We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95 % CI 1.05-1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95 % CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. CONCLUSION: MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.KEY WORDS: adherence; behavioral medicine; patient engagement.

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Section: Introductionmentioning

confidence: 99%

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

et al. 2016

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“…The key concepts of motivational interviews are the participant recognising and accepting the need to make changes in their lives; this approach encourages the participants to consider their readiness to change their behaviour [11,12]. For this reason motivational interviews are commonly associated with targeting changing addictive behaviours, [13][14][15][16][17] and they have recently been used with adolescents [18] and pregnant women [19][20][21]. However, the evidence of their effectiveness to improve contraceptive use includes conflicting findings, with some studies reporting an improvement and others reporting no effect.…”

Section: Introductionmentioning

confidence: 99%

Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis

Wilson

Nirantharakumar

Truchanowicz

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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“…16 These counseling techniques can be easily incorporated into well-child visits without taking excess time, which is important because insufficient time, especially among FPs, was the most often cited barrier to assessment and management of diet and physical activity. 10,17 In order for providers to be able to counsel patients on behavior and lifestyle changes, they need to be adequately paid for their time. FPs were more likely to report inadequate reimbursement as a barrier and better reimbursement as a needed improvement to providing weight-managementrelated counseling.…”

Section: Childhood Obesity April 2015mentioning

confidence: 99%

“…18 In one study, a diagnosis of obesity, even with comorbidities listed, was consistently denied payment, whereas the diagnoses of abnormal weight gain, insulin resistance, and/or hyperlipidemia were paid by most health insurance providers. 17 Insurers are also more likely to pay for surgical treatments of obesity than nonsurgical treatments, such as dietary counseling. 19 Better payment for weight-management-related counseling was one of the many driving factors in the recent declaration by the American Medical Association that obesity is, in fact, a disease.…”

Section: Childhood Obesity April 2015mentioning

confidence: 99%

Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

Vos¹,

Walsh²,

O’Brien³

et al. 2015

Childhood Obesity

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Background: Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role.Purpose: The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgia's PCPs.Methods: In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value < 0.05.Results: The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p £ 0.002) and screen time (86% vs. 74-75%; p £ 0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p < 0.001) and to track progress (50% vs. 35-39%; p < 0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%).Conclusions: Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.

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Providers as Weight Coaches: Using Practice Guides and Motivational Interview to Treat Obesity in the Pediatric Office

Cited by 32 publications

References 11 publications

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis

Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

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