Use of an Electronic Medical Record System to Support Primary Care Recommendations to Prevent, Identify, and Manage Childhood Obesity

Abstract

Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medical record system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medical record system enhancements, challenges to development and implementation exist. Pediatrics 2009;123:S100-S107 O VER THE PAST 3 decades, the national prevalence of overweight has tripled for children and adolescents. 1 Approximately 37% of Delaware children have a BMI of Ն85th percentile, making them overweight or obese. 2 Important psychological and medical consequences of excess weight and antecedents of adult disease occur in obese children and adolescents. In addition, obese children and adolescents are more likely to become overweight or obese adults; this concern is greatest among adolescents. 3 Childhood obesity is a complex problem that must be addressed in the multiple settings in which children spend their time. Although primary care interventions alone will not resolve the obesity epidemic, addressing this issue in the primary care setting is an important component of the overall approach to resolving this crisis. Expert recommendations for addressing childhood overweight in this setting have been in existence for a decade, 4 and new expert recommendations were released recently. 5 These recommendations include guidance for assessment of overweight, obesity, and comorbid conditions, as well as assessment and counseling on associated dietary, physical activity, and sedentary behaviors.Multiple studies have revealed that many primary care practitioners are not providing care that is consistent with these recommendations. 6-10 An example of an overused test is thyroid function testing. Although such testing is not recommended by the American Academy of Pediatrics, O'Brien et al 8 found that the majority of physicians who requested laboratory studies for the initial treatment of overweight children included thyroid function studies. Kologatla and Adams 11 found that knowledge of guidelines was not associated with adherence; although 19% of physicians were aware of the national recommendations, only 3% reported adhering to all of them.For primary care clinicians, barriers to providing the recommended care to address childhood obesity include lack of self efficacy, 12,13 inadequate tools or resources, 14,15 insufficient knowledge and skills, 12,14,16 lack of time, [11][12][13]17,18 competing priorities, 19 insufficient reimbursement, [11][12][13]19 and lack of awareness of community resources. 20 Cabana et al 21 found that self-efficacy was associated with guideline implementation. Perrin et al 22 demonstrated an association between pediatrician self-efficacy regarding obesity counseling and access to tools, especially electronic tools. In another study, phys...

Mismatch between the prevalence of overweight and obese children and adolescents and recording in electronic health records: a cross-sectional study

“…The availability of reminders or alerts may prompt actions to promote healthy lifestyle behaviours in the outpatient setting. 9,17 However, our results show that even in severely obese children (Z 3), a diagnosis was not registered in 66.1% of cases, suggesting that use of a more sensible anthropometric tool is not enough, and additional medical education is needed to increase the detection of overweight and obesity. By contrast, when the diagnosis was registered, most of the patients were referred to specialists.…”

“…8 An electronic health record (EHR) can be used to identify and manage overweight and obesity by providing timely information, educating providers regarding their own performance, and guiding child care by the implementation of guidelines and recommendations to help facilitate quality improvement efforts. 9 The primary objective of this study is to compare the prevalence of overweight and obesity in a paediatric population based on BMI and clinical diagnosis as recorded in an EHR with healthcare information provided by a Health Medical Organisation (HMO). In addition, referral to specialists and the ordering of laboratory tests are compared based on both criteria.…”

Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial

“…12 Electronic health record (EHR) systems have the potential to overcome these barriers through computerized decision support tools to remind physicians to counsel overweight patients and linked resources to facilitate a structured, evidence-based approach to counseling. 13,14 The purpose of this study was to evaluate a set of electronic tools to assist with identification and counseling of overweight patients in a general internal medicine (GIM) clinic. We hypothesized that the tools would increase physician documentation of overweight, increase documented weight counseling and goal-setting among overweight patients, and facilitate patient progress toward their goals.…”

An Intensive Family Intervention Clinic for Reducing Childhood Obesity

“…6 The primary care setting provides the opportunity for interventions to reduce childhood obesity, such as those successfully reported in the United Kingdom, the United States, and Singapore. [7][8][9][10] There is moderate-to high-strength evidence that diet and/or physical activity interventions implemented in school settings help prevent weight gain or reduce the prevalence of overweight and obesity, as noted in a 2013 report from the American Agency for Health Research and Quality. 11 The generalizability of evidence of the effectiveness of interventions primarily implemented in other settings is largely unknown.…”