Top PDF Overweight and Obesity and the Demand for Primary Physician Care

Overweight and Obesity and the Demand for Primary Physician Care

Overweight and Obesity and the Demand for Primary Physician Care

for young people who rarely get health care checkups done, but who make up the group which has experienced the fastest rise in obesity in recent times 3 . In this paper we look at a selected group (i.e. wage earners) of relatively healthy people in different weight categories to see whether people in higher weight categories who have a higher risk of lifestyle diseases use more primary physician care. A large epidemiological literature has established a clear positive association between BMI (or some other measure of overweight/obesity) and medical consumption. Most of these studies derive estimates of health care costs of obesity using ‘population attributable risk’ methods which relate the proportion of cases of a particular disease (diabetes, for example) to obesity (see, e.g., Ministry of Health and Prevention, 2007). A few studies are based on prospective cohort analysis which tracks the subsequent health care usage of a single cohort which is selected on the basis of exposure rather than disease. However, both types of analyses can at best uncover correlations and furthermore, are sensitive to selection or attrition problems. We are not aware of research which has directly examined the impact of being overweight and obese on the demand for medical care by employing a very general method which allows for varying intensities of medical care use on the basis of the frailty in the data.
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Obesity and the Demand for Canadian Physician Services

Obesity and the Demand for Canadian Physician Services

There are limitations about what can be learned about the effects of excess weight on both health and health service utilization rates from surveys like the Canadian Community Health Survey. This survey does not collect much retrospective information. Having data on the respondent’s weight history is a much better alternative to a statistical procedure which attempts to control for the variation in age at first obesity. BMI is a widely used measure of being overweight or obese. But many studies have shown that the location of adipose tissue is also important in determining health risks. This information is easy to collect and it is probably time for Statistics Canada to design a survey which is exclusively devoted to assessing the population’s physical characteristics and health histories as they relate to the obesity problem.
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Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial

Obesity is a problem that affects people in both devel- oped and developing countries. Brazil has been undergo- ing a rapid demographic, nutritional and epidemiological transition accompanied by an increase in obesity in dif- ferent population groups. In the current epidemiological setting, which has seen a decline in rates of infectious diseases, there has been a noteworthy rise in noncom- municable chronic diseases (NCDs), including obesity. With this has come increased caloric intake associated with adipose tissue gain and concomitantly a risk factor for other NCDs, such as hypertension, diabetes, cardio- vascular disease and cancer. This is a critical public health problem, particularly in Brazil, where 72% of deaths are related to such diseases [1]. More than half of the Brazilian population is overweight, and obesity cur- rently affects 20% of adults [2]. A study of food con- sumption between 1970 and 2009 showed a trend of increasing consumption of ultra-processed foods (baked goods, sausages, soft drinks, ready meals), and the re- searchers in that study also noted a reduction in the consumption of basic foods such as eggs, animal fats, fish, roots, tubers and rice, aside from the consumption of fruits and vegetables, which remained stable, albeit representing less than half of the recommended daily in- take [3].
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Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: Study protocol for a randomised controlled trial

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: Study protocol for a randomised controlled trial

Background Obesity is a problem that affects people in both devel- oped and developing countries. Brazil has been undergo- ing a rapid demographic, nutritional and epidemiological transition accompanied by an increase in obesity in dif- ferent population groups. In the current epidemiological setting, which has seen a decline in rates of infectious diseases, there has been a noteworthy rise in noncom- municable chronic diseases (NCDs), including obesity. With this has come increased caloric intake associated with adipose tissue gain and concomitantly a risk factor for other NCDs, such as hypertension, diabetes, cardio- vascular disease and cancer. This is a critical public health problem, particularly in Brazil, where 72% of deaths are related to such diseases [ 1 ]. More than half of the Brazilian population is overweight, and obesity cur- rently affects 20% of adults [ 2 ]. A study of food con- sumption between 1970 and 2009 showed a trend of increasing consumption of ultra-processed foods (baked goods, sausages, soft drinks, ready meals), and the re- searchers in that study also noted a reduction in the consumption of basic foods such as eggs, animal fats, fish, roots, tubers and rice, aside from the consumption of fruits and vegetables, which remained stable, albeit representing less than half of the recommended daily in- take [ 3 ].
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Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England

Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England

We also worked closely with the obesity lead to im- prove their knowledge of the care of overweight and obese patients and to identify additional resources and tools which may be useful. We also asked teams during the intervention workshop to discuss barriers within their own practices and ways in which they could be overcome. This led to some local adaptation of the intervention to meet practice needs. For example, one practice suggested that paying for fresh food and gym membership was an issue. In response, we provided a healthy eating on a budget leaflet for use with patients. We also provided additional leaflets for particular groups of patients. These included a leaflet on how diet can affect diabetes, high blood pressure and cholesterol, a leaflet on how food can improve a person’s mood, healthy packed lunches and healthy South Asian food.
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Improving Provider Adherence to Guidelines in Addressing Childhood Overweight and Obesity in A Primary Care Setting

Improving Provider Adherence to Guidelines in Addressing Childhood Overweight and Obesity in A Primary Care Setting

According to the WHO (2016), BMI is a simple and resourceful tool that can assist in screening and identifying overweight and obesity based on a person’s height and weight measurements. The USPSTF (2016) recommends that primary care providers calculate BMI percentiles at every opportunity in order to assist in screening and identifying children who are at risk of having an unhealthy weight status. BMI is attained by calculating a person’s weight in kilograms and dividing this number by a person’s height in meters, squared (Buttaro, Trybulski, Bailey, & Sandber-Cook, 2013). In some primary care settings BMI can be taken manually or automatically calculated through the use of an electronic medical record (EMR) program. According to Apovian and Gordon (2014), the BMI is limited from identifying the total distribution of fat in the body but it is quite useful for screening and identifying individuals at high risk for overweight and obesity. Hence, BMI is a tool that can assist in identifying individuals at abnormal weight levels, as well as a guide for providers in taking appropriate measures and diagnoses of comorbidities or conditions associated with overweight and obesity.
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Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy—The Maine Youth Overweight Collaborative

Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy—The Maine Youth Overweight Collaborative

This evaluation of the MYOC documents the success of clinicians in 12 sites located throughout Maine in effec- tively changing practices that can identify, prevent, and treat childhood overweight. Study results indicate large changes in clinical practice from before to during imple- mentation of the MYOC: increases in assessment of BMI percentile for age and gender, use of the 5-2-1-0 behav- ioral screening tool, and weight classification. Indepen- dent parent surveys indicate improvements in providers discussing the 5-2-1-0 behavioral targets: nutrition, TV time, physical activity, and sugar-sweetened drinks from before to during the MYOC. Control sites were identi- fied, and during-MYOC intervention data from parent surveys indicate higher rates of counseling at the last well-child visit for all the 5-2-1-0 targets in intervention versus control sites (fruits and vegetables, physical activ- ity, TV, and sugar-sweetened drinks). Consistent with these data, providers at the intervention sites reported improvements in knowledge, attitudes, self-efficacy, and practice, including medical evaluation of overweight pa- tients, counseling on 5-2-1-0 targets, use of goal setting, and motivational interviewing.
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Evaluation of a tailored intervention to improve management of overweight and obesity in primary care: study protocol of a cluster randomised controlled trial

Evaluation of a tailored intervention to improve management of overweight and obesity in primary care: study protocol of a cluster randomised controlled trial

health care is delivered through general practices. Around 98% of the population is registered with a gen- eral practice, practices having registered lists of patients, electronic record systems, and multidisciplinary primary care teams that include doctors, nurses, and health care assistants [17]. Practices are paid through a combination of capitation and pay for performance schemes, notably the quality and outcomes framework (QOF) and pay- ments for enhanced services. Practices vary widely in size, although the mean size is approximately 6,800 pa- tients [17]. In 2012, there were 8,088 general practices in England, 921 of which were classified as single-handed. There were 35,871 full time equivalent general practi- tioners (GPs), 14,695 full time equivalent practice nurses, and 70,851 full time equivalent practice staff in other categories. The total number of patients registered with GPs in England was 55.7 million (patients are re- quired to register with a single practice in order to re- ceive primary care).
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Managing Childhood Obesity in a Primary Care Clinic

Managing Childhood Obesity in a Primary Care Clinic

initiative with one of the practices interventions being learning collaboratives to provide tools, training, and technical assistance to implement the 2007 and ongoing Expert Committee recommendations in primary care practices statewide, potentially impacting a total population of 33,000 children (Chang, Gertel-Rosenberg, Drayton, Schmidt, & Angalet, 2010). At the end of the 2-year administration in Delaware, although the prevalence of overweight and obesity showed no significant difference, there was a significant increase of healthy eating and physical activity awareness throughout the state (Chang et al., 2010). Children that exercised for more than 1 hour went up from 10% to 26% and moderate to vigorous physical activity for more that 20 minutes rose from 21% to 33% (Chang et al., 2010). Eighty-one percent of participation centers attested to its effectiveness. A huge decrease in the amount of time spent on TV or computer screens was noted. An increase in the consumption of vegetables and fruits was seen (Chang et al., 2010). It is also important to note that the Expert Committee recommendations were supported and promoted as a guideline for primary care systems nationwide.
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Chapter Title: Managing Physician Panels in Primary Care

Chapter Title: Managing Physician Panels in Primary Care

The adoption of open access, which promises patients same-day appointments, has prompted a series of questions. What should physician panel sizes be to allow open access? What if patients prefer to have appointments at some future time rather than see a doctor the same day? These questions have necessitated the use of queuing and stochastic optimization approaches that provide guidelines to practices. For instance, Green et al. (2007) investigate the link between panel sizes and the probability of “overflow” or extra work for a physician under advanced access. They propose a simple probability model that estimates the number of extra appointments that a physician could be expected to see per day as function of her panel size. The principal message of their work is that for advanced access to work, supply needs to be in sufficiently higher than demand to offset the effect of variability. Green and Savin (2008) use a queuing model to determine the effect of no-shows on a physician's panel size. They develop analytical queuing expressions that allow the estimation of physician backlog as a function of panel size and no-show rates. In their model, no show rates increase as the backlog increases; this results in the paradoxical situation where physicians have low utilization even though backlogs are high -- this is because patients, because they have had to wait for long, do not show up.
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Pre-exercise screening: role of the primary care physician

Pre-exercise screening: role of the primary care physician

Physical inactivity is a global health problem that is vital to the primary prevention of over 35 chronic diseases [1, 2]. Moreover, exercise is an important treatment component for some of the most prevalent, costly, and deadly chronic diseases and health conditions in the world, including car- diovascular disease (CVD), diabetes mellitus, some forms of cancer, obesity, dyslipidemia, and hypertension, among others [3 – 6]. To achieve these health benefits adults are recommended to accumulate 150 min/wk of moderate in- tensity or 75 min/wk of vigorous intensity physical activity, or some combination of the two, on most, preferably all, days of the week [6]. Children and adolescents are advised to achieve 60 min of moderate to vigorous physical activity 7 days per week.
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The contribution of Physician Assistants in primary care: a systematic review

The contribution of Physician Assistants in primary care: a systematic review

According to the literature presented, the number of PAs in family practice has increased over the profession’s 40-year history with approximately 50% working in fa- mily practice. Retention of PAs is considered possible if the conditions of the local area, as well as their employ- ment, fit their personal circumstance. Clinician support for the profession is reported to be high, particularly amongst those already employing PAs, though some consider it to be a low salaried position. PAs are also considered to be expensive, because their work involves low revenue-generating patients. The apparent support for PAs, coupled with increasing numbers, appears to fit with a picture of need in terms of workload demand in family practice. The evidence for this comes in the stud- ies that describe that the consultation type carried out by PAs is the acute, often undifferentiated caseload in family practice, with some suggestion however that the doctors see the older patients with more chronic or se- rious conditions. PAs are presented in several studies to potentially increase the workload of others through the need for supervision and (in the UK in particular) for prescribing support, though they may also enable an in- crease in physician or practice productivity. Acceptability to patients appears to be very high in actual and hypo- thetical situations, although it was reported that there were conditions patients would prefer to see a doctor for. Other reports on the outcomes of care are positive in the main, though limited, with surprisingly little on the appropriateness of the care provided for the major reported workload group of acute conditions. When summarised against the contemporarily used three di- mensions of quality – patient safety, effectiveness of care and patient experience - in the UK NHS [80], the review suggests that some supportive evidence for the PA in general practice has been found in each of these dimen- sions, albeit in limited form outside of patient experi- ence. However, there are a number of caveats to the support regarding patient safety and effectiveness of care as the findings do not provide robust evidence and there is a complete absence of studies in some areas.
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Assessment of Pediatric Primary Care Providers Behaviors and Procedures Regarding Pediatric Overweight and Obesity

Assessment of Pediatric Primary Care Providers Behaviors and Procedures Regarding Pediatric Overweight and Obesity

Aim The primary objective of this literature review was to investigate current clinical practices of primary care providers in relation to pediatric overweight/obesity. Articles in relation to current barriers in the primary care setting and resources providers found useful were also included. An integrative review was performed to identify articles relevant to the aim. Inclusion criteria included articles published after 2004 written in English. Articles published related to pediatric overweight/obesity educational interventions, screening methods, and referral practices in the primary care setting were reviewed. Identifying screening and referral patterns can give insight into where to focus education for primary care providers. Articles meeting inclusion criteria were selected from a search of Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, and EBSCO host database. The literature review involved searching for studies about the identification and treatment of pediatric obesity by primary care providers in the outpatient setting, and the feasibility of current interventions and guidelines.
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Implementation of a Primary Care Physician Network Obesity Management Program

Implementation of a Primary Care Physician Network Obesity Management Program

A patient–physician Guide to Healthy Weight Loss Worksheet was developed for physicians and patients to complete. Information gathered from the patient portion of the worksheet allows the physician to assess the patient’s readiness to change, and the portion of the worksheet com- pleted by the physician promotes his or her role as a partner in treatment. Handouts for patient use were also developed. Meal plans for 1200- and 1500-calorie diets, incorporating the use of meal replacements and portion-controlled meals, were designed for simplicity of explanation and implemen- tation. Supporting handouts, which provide caloric values for fruits, vegetables, and starchy vegetables in the meal plan; information on the use of meal replacements and the avoidance of trigger foods; and the value of regular exercise complete the patient education materials packet. A patient enrollment form was also developed, which was designed to collect patient information regarding weight, height, BMI, body fat percentage and target weight, comorbid conditions, calorie level prescribed, and prescription medications given, if any. On the same form, the patient signs and indicates the days and times that they prefer to be called by the dietitian. Once all of the materials were developed, interested phy- sicians were visited personally for an introduction to the program. A notebook containing the implementation guide- lines and handout masters were provided to each physician,
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Primary Care in Tennessee: The Gap between Demand and Physician Supply

Primary Care in Tennessee: The Gap between Demand and Physician Supply

hospitalizations, 13 early hospital readmissions, 14 and emergency department utilization for nonurgent conditions. 15 In one report, the addition of one primary care physician per 10,000 population was associated with a reduction in 30-day post-hospital discharge readmissions for pneumonia, myocardial infarction, and congestive heart failure of 7.0 percent, 5.0 percent, and 8.0 percent, respectively; adding one primary care physician per 100,000 population was estimated to reduce the cost of these readmissions by $1.7 million. The preponderance of data also document an inverse relation between primary care services and overall health care costs; for example, Michael Chernew and associates reported that in 2005 a ten percentage point increase in the proportion of physicians practicing primary care was associated with a 9.2 percent reduction in Medicare spending per beneficiary. 16
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The time burden of overweight and obesity in primary care

The time burden of overweight and obesity in primary care

Although 8% is likely an underestimate, these results offer a qualitatively different way to assess how over- weight and obesity affect primary care medical practice. The results suggest that, in a hypothetical situation where all patients have a BMI < 25 kg/m 2 , PCPs would have nearly 40 more minutes in their day. Forty minutes would be enough to see 2 additional patients, or alterna- tively, to spend a few more minutes with each patient to improve quality of care (e.g., to raise cancer screening rates). These results extend the work of Pearson et al, who used NAMCS data and found that visits for obese patients were slightly longer and involved a significantly greater number of medications prescribed [20]. The results also extend the work of Bertakis and Azari, who Table 3 Odds ratios and attributable fractions (AFs) for receiving a diagnosis code or having a medication prescribed during the office visit*
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Primary Care Physician Shortage: Increased Demand and Insufficient Supply

Primary Care Physician Shortage: Increased Demand and Insufficient Supply

One delivery model proposed in the ACA is the Patient Centered Medical Home (PCMH). The PCMH model is centered on the PCP, who is in charge of providing continuous and coordinated care to patients to ensure better management of illnesses. The PCP works as part of a highly-coordinated team of providers, including specialists, practice care managers, social workers, dieticians, mid-level providers, pharmacists, and family and community occupation therapists (Rosenthal, 427). PCMHs main focus is on “interdisciplinary team practice, payment reform, increased utilization of information technologies, and increased patient access and involvement” (Berryman et al., 167). Furthermore, “evidence shows that patients with a medical home have better access to care, are more likely to receive recommended preventative services, and have chronic conditions that are better managed compared with those lacking a medical home” (Abrams et al., 8). Evidence also suggests that patients in a medical home are less likely to receive duplicate tests, report errors in their care, or go to the emergency room, which can lead to cost savings due to decreased hospitalizations and emergency room use (Abrams et al., 8).
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An Evaluation of Childhood Overweight and Obesity Screening and Management in the Primary Care Setting

An Evaluation of Childhood Overweight and Obesity Screening and Management in the Primary Care Setting

One of the strongest predictors of childhood obesity is the BMI of the paternal parents. The inheritability of obesity is approximately 64-84% (Stunkard, Foch, & Hrubec, 1986). Studies have identified a strong association between the fat-mass and obesity-associated (FTO) gene and BMI (Vos & Welsh, 2010). The melanocortin 4 receptor gene is associated with obesity in children as its deficiency leads to hyperphagia, hyperinsulinemia, and increased body mass (Vos & Welsh, 2010). Therefore, it is important for providers to assess family history of obesity to provide early obesity prevention measures. Although genetic risk factors do not solely determine a child’s weight, they do play a large role in determining how a child will respond to the environmental factors of diet and physical activity (Lyon & Hirschhorn, 2016). In addition, infants of diabetic mothers and infants with intrauterine growth retardation are at increased risk of childhood obesity (Prevention and management of obesity, 2013).
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Obesity prevalence. Overweight/obesity by education. Overweight/obesity by age. Overweight/obesity by region

Obesity prevalence. Overweight/obesity by education. Overweight/obesity by age. Overweight/obesity by region

The Iranian health system has undergone several reforms in the past few decades. Currently, there is considered to be universal coverage of primary care services, but there are continued challenges for secondary and tertiary care. Primary care is fully financed by the government. The “Health Network System” was established in 1986 to increase access to primary care, and now health networks are accessible to all and provide basic preventative and treatment services mostly free of charge. The fact that public coverage extends only to primary care is relatively unique.
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Physician interactions with electronic health records in primary care

Physician interactions with electronic health records in primary care

staff member authorized to work with patient data. A research specialist affiliated with the clinic contacted candidate patient participants by phone 2 days before their clinical appointment. The research specialist de- scribed the study, invited the patients to participate in the study, and asked them to arrive at the clinic 15 min early to complete the informed consent procedures. Patients who scheduled their visits within the last few days were invited to participate, on the day of their visit, by the receptionist with a standardized script explaining the study. No new patients of physicians were recruited to mitigate the potential effects of processes related to first- time encounters. Informed consent was obtained from both patient and physician participants. The study protocol was approved by university and clinic Institu- tional Review Boards and HIPAA (Health Insurance Portability and Accountability Act) regulations were fulfilled. All visits were recorded with high-resolution video cameras. Ten patients per physician were recruited; 56 males and 44 females comprised the patient group. Seventy-eight participants were White/Caucasian. Of the patients, 10 had some high school education, 27 were high school graduates, 24 had some college education, and 39 were college graduates. Patients were between
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