1
|
Kirbach K, Marshall-Moreno I, Shen A, Cullen C, Sanigepalli S, Bobadilla A, MacElhern L, Grunvald E, Kallenberg G, Tristão Parra M, Sannidhi D. Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program. Front Nutr 2024; 11:1338727. [PMID: 38962444 PMCID: PMC11220244 DOI: 10.3389/fnut.2024.1338727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/24/2024] [Indexed: 07/05/2024] Open
Abstract
Background Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Methods Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. Results 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. Conclusion The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.
Collapse
Affiliation(s)
- Kyleigh Kirbach
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Alice Shen
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Curtis Cullen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | | | - Alejandra Bobadilla
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Lauray MacElhern
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Eduardo Grunvald
- Bariatric and Metabolic Institute, University of California San Diego, San Diego, CA, United States
| | - Gene Kallenberg
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Deepa Sannidhi
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
| |
Collapse
|
2
|
Pantalone KM, Rogen B, Zirm P, Xiao H, Bena J, Barnard G, Borukh E, Peechakara S, Griebeler ML, Young JB, Burguera B. An Obesity-Centric Approach with and Without Anti-Obesity Medications Compared to the Usual-Care Approach to Management of Patients with Obesity and Type 2 Diabetes in an Employer Setting: A Pragmatic Randomized Controlled Trial (EMPOWER-T2D). Diabetes Ther 2024; 15:1201-1214. [PMID: 38573466 PMCID: PMC11043250 DOI: 10.1007/s13300-024-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION This study aimed to compare weight loss and glycated hemoglobin (HbA1c)-reduction effects of two obesity-centric, weight-loss management approaches (with or without anti-obesity medication) versus usual glucose-centric care in patients with obesity and type 2 diabetes. METHODS Single-center, randomized, open-label, 3-armed, parallel-group, pragmatic, noninferiority trial, July 2020 to August 2022. Adults enrolled in the Cleveland Clinic Employee Health Plan (body mass index [BMI] ≥ 30 kg/m2, type 2 diabetes diagnosis, HbA1c > 7.5%) were randomized to usual glucose-centric management ("Usual-Care" group) or one of two obesity-centric management strategies: participation in a weight management program plus anti-obesity medication ("WMP + AOM" group), or WMP participation without anti-obesity medication ("WMP-Only" group). Primary endpoints were changes in weight and HbA1c, baseline to month 12. RESULTS Due to enrollment and retention challenges, largely related to COVID-19, only 74/300 planned participants were randomized and the study was terminated early. Participants were predominantly female (59%), median (interquartile range [IQR]) age 53.5 (47, 60) years, 68% white, with baseline median (IQR) BMI and HbA1c of 37.4 (34.2, 42.7) kg/m2 and 8.8% (7.9%, 10.4%), respectively. At month 12, mean (90% confidence interval [CI]) percentage weight change in the Usual-Care, WMP-Only, and WMP + AOM groups was - 4.5% (- 6.5%, - 2.5%), - 6.7% (- 8.7%, - 4.7%), and - 8.7% (- 10.7%, - 6.8%), respectively; mean (90% CI) HbA1c change was - 1.7% (- 2.1%, - 1.2%), - 2.2% (- 2.7%, - 1.8%), and - 2.2% (- 2.6%, - 1.7%), respectively. WMP + AOM was superior to Usual-Care for weight change (P = 0.02); both WMP + AOM and WMP-Only were noninferior (P ≤ 0.01) to Usual-Care for change in HbA1c. CONCLUSIONS Including anti-obesity medication was associated with superior weight loss with noninferior HbA1c reductions, warranting further evaluation in larger study populations of obesity-focused approaches to type 2 diabetes management. Graphical abstract available for this article. TRIAL REGISTRATION ClinicalTrials.gov NCT03799198.
Collapse
Affiliation(s)
- Kevin M Pantalone
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce Rogen
- Employee Health Plan, Cleveland Clinic, Cleveland, OH, USA
| | - Patty Zirm
- Employee Health Plan, Cleveland Clinic, Cleveland, OH, USA
| | - Huijun Xiao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Gretchen Barnard
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Elena Borukh
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Seenia Peechakara
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Marcio L Griebeler
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - James B Young
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA
| | - Bartolome Burguera
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
3
|
Le Jemtel TH, Samson R, Oparil S. Integrated Care Model of Adiposity-Related Chronic Diseases. Curr Hypertens Rep 2022; 24:563-570. [PMID: 36083439 DOI: 10.1007/s11906-022-01223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. RECENT FINDINGS The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.
Collapse
Affiliation(s)
- Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
Walker R, Ramasamy V, Sturgiss E, Dunbar J, Boyle J. Shared medical appointments for weight loss: a systematic review. Fam Pract 2022; 39:710-724. [PMID: 34536073 DOI: 10.1093/fampra/cmab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Shared medical appointments (SMAs) may help mitigate some of the barriers for managing obesity in primary care. The primary aim of this systematic review was to measure the effect of weight loss SMAs. METHODS Systematic searches using keywords and Medical Subject Headings for overweight, obesity, and SMAs were conducted in the CENTRAL, Medline Complete, PsycINFO, Scopus, CINAHL, EMBASE, and Web of Science databases with no date limits. Risk of bias was assessed using the Effective Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS Fifteen studies involving weight loss SMAs in adults and children were identified. Six studies had controls. Inconsistency in reporting weight loss or weight change in controlled studies meant that data could not be pooled for meta-analysis. Results from individual studies indicated that SMAs can support adult patients to achieve significant weight loss. Women and older adults were more likely to take up SMA invitations. Results from the 5 studies involving children were less conclusive. Studies involving participants of a higher socioeconomic status tended to report lower attrition than studies involving participants who experienced disadvantage. These findings should be interpreted with caution as all but 1 included study was assessed as being weak in quality. CONCLUSIONS Overall, SMAs may be of benefit to address obesity in primary care, particularly for women and older adults. Appropriately designed prospective and controlled studies are required to engage their target audience and to assess whether SMAs are superior to other weight loss options in primary care.
Collapse
Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Vijayanand Ramasamy
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Elizabeth Sturgiss
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Notting Hill, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| |
Collapse
|
5
|
Wei J, Lei L, Shieh A, Gupta D, Ahern S, Shen N. Program for Reducing Obesity (PRO): An institutional review of an insurance-based weight loss program utilizing shared medical appointments. Obes Sci Pract 2022; 8:272-278. [PMID: 35664242 PMCID: PMC9159562 DOI: 10.1002/osp4.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Based on CDC estimates in the United States, the prevalence of obesity was 42.4% in 2017-2018, and the annual cost of obesity was $147 billion in 2008. Yet studies estimate that only 20-40% of adults with obesity received counseling from their primary care providers. Recent studies using shared medical appointments (SMA), where patients are seen by a multidisciplinary team, have shown promising results in obesity management. We developed an insurance-based weight loss program incorporating SMA, called the Program for Reducing Obesity (PRO), and report our findings here. Methods Enrollment began in January 2019 at the UCLA Health Thousand Oaks clinic. Patients age ≥18 years with BMI ≥30 kg/m2 were eligible by referral to PRO, a program consisting of individual visits and SMAs with an obesity medicine board certified endocrinologist and registered dietitian. Primary outcomes were change in weight after 3, 6, and 12 months. Secondary outcomes included proportion that achieved ≥5% weight loss, change in percent body fat, HbA1c, HDL, triglycerides, and blood pressure. Results 102 patients (mean age 59.7 years, 72% women, mean weight 103.6 kg, mean BMI 36.6 kg/m2) have been analyzed, with 91 patients completing at least 12 months of the program. Patients achieved significant weight loss: 3.0%, 5.0%, and 7.8% of their baseline weight after 3, 6, and 12 months respectively. 52% of patients lost ≥5% of their baseline weight after 12 months. Patients had significant reductions in body fat: 2.1%, 7.4%, and 6.7% of their baseline (all p ≤ 0.01) after 3, 6, and 12 months respectively. Improvements were also seen in HbA1c (p ≤ 0.01), triglycerides (p ≤ 0.04), and systolic blood pressure (p ≤ 0.07) after 12 months although not all results achieved statistical significance. Conclusion Our institutional review of PRO, an insurance-based obesity program utilizing SMA, demonstrates a successful approach to promoting weight loss in a community-based setting.
Collapse
Affiliation(s)
- Jeffrey Wei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Lei Lei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Albert Shieh
- Division of GeriatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Deepashree Gupta
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Susan Ahern
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Na Shen
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| |
Collapse
|
6
|
Grewal US, Brown T, Mudigonda GR, Davila-Chapa C, Thotamgari SR, Crooms C, Singh JS, Mahadevan R. Using Shared Medical Appointments for Delivering Patient-Centered Care to Cancer Survivors: A Feist-Weiller Cancer Center Pilot Study. J Patient Exp 2022; 9:23743735211069834. [PMID: 35071749 PMCID: PMC8772348 DOI: 10.1177/23743735211069834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Shared medical appointments (SMAs) have shown promise in the care of patients with conditions such as diabetes; however, the impact of lifestyle medicine-based SMAs on the overall health status of cancer survivors remains poorly understood. Materials and Methods: This cross-sectional survey of patients was conducted to study the impact of a unique lifestyle medicine-based survivorship program on cancer survivors. Results: A total of 64 patients were telephonically contacted for the survey, out of which 39 (60.9%) patients responded. All patients (39 of 39, 100%) found the program to be helpful in some way; 26 patients (66.7%) found SMAs to be significantly helpful, while 13 patients (33.3%) found SMAs as only somewhat helpful. The majority noted feeling a great sense of support (35 of 39, 89.7%), followed by improvement in appetite (21 of 39, 54%) and improvement in pain (14 of 39, 35.9%). All patients reported at least some improvement in subjective well-being (SWB); patients who attended >3 appointments reported significant/very significant improvement in SWB (P = .03). Conclusion: SMAs offer promise in the effective delivery of lifestyle medicine-focused care to cancer survivors. Further prospective studies are needed to validate these findings.
Collapse
Affiliation(s)
- Udhayvir S Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Tyiesha Brown
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Ghanshyam R Mudigonda
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Cesar Davila-Chapa
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Sahith R Thotamgari
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Carol Crooms
- Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Jennifer S Singh
- Feist-Weiller Cancer Center, Shreveport, LA, USA
- Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Rupa Mahadevan
- Feist-Weiller Cancer Center, Shreveport, LA, USA
- Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
7
|
Mariam A, Miller‐Atkins G, Pantalone KM, Iyer N, Misra‐Hebert AD, Milinovich A, Bauman J, Mocarski M, Ramasamy A, Smolarz BG, Hobbs TM, Zimmerman RS, Burguera B, Kattan MW, Rotroff DM. Associations of weight loss with obesity-related comorbidities in a large integrated health system. Diabetes Obes Metab 2021; 23:2804-2813. [PMID: 34472680 PMCID: PMC9292723 DOI: 10.1111/dom.14538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 01/01/2023]
Abstract
AIMS To determine the health outcomes associated with weight loss in individuals with obesity, and to better understand the relationship between disease burden (disease burden; ie, prior comorbidities, healthcare utilization) and weight loss in individuals with obesity by analysing electronic health records (EHRs). MATERIALS AND METHODS We conducted a case-control study using deidentified EHR-derived information from 204 921 patients seen at the Cleveland Clinic between 2000 and 2018. Patients were aged ≥20 years with body mass index ≥30 kg/m2 and had ≥7 weight measurements, over ≥3 years. Thirty outcomes were investigated, including chronic and acute diseases, as well as psychological and metabolic disorders. Weight change was investigated 3, 5 and 10 years prior to an event. RESULTS Weight loss was associated with reduced incidence of many outcomes (eg, type 2 diabetes, nonalcoholic steatohepatitis/nonalcoholic fatty liver disease, obstructive sleep apnoea, hypertension; P < 0.05). Weight loss >10% was associated with increased incidence of certain outcomes including stroke and substance abuse. However, many outcomes that increased with weight loss were attenuated by disease burden adjustments. CONCLUSIONS This study provides the most comprehensive real-world evaluation of the health impacts of weight change to date. After comorbidity burden and healthcare utilization adjustments, weight loss was associated with an overall reduction in risk of many adverse outcomes.
Collapse
Affiliation(s)
- Arshiya Mariam
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Galen Miller‐Atkins
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | | | | | - Anita D. Misra‐Hebert
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
- Department of Internal Medicine, Cleveland Clinic Community CareCleveland ClinicClevelandOhioUSA
- Healthcare Delivery and Implementation Science CenterCleveland ClinicClevelandOhioUSA
| | - Alex Milinovich
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Janine Bauman
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | | | - Michael W. Kattan
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Daniel M. Rotroff
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
- Endocrinology and Metabolism InstituteCleveland ClinicClevelandOhioUSA
| |
Collapse
|
8
|
Pantalone KM, Smolarz BG, Ramasamy A, Baz Hecht M, Harty BJ, Rogen B, Griebeler ML, Borukh E, Young JB, Burguera B. Effectiveness of Combining Antiobesity Medication With an Employer-Based Weight Management Program for Treatment of Obesity: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116595. [PMID: 34255049 PMCID: PMC8278271 DOI: 10.1001/jamanetworkopen.2021.16595] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The clinical efficacy of antiobesity medications (AOMs) as adjuncts to lifestyle intervention is well characterized, but data regarding their use in conjunction with workplace wellness plans are lacking, and coverage of AOMs by US private employers is limited. OBJECTIVE To determine the effect of combining AOMs with a comprehensive, interdisciplinary, employer-based weight management program (WMP) compared with the WMP alone on weight loss, treatment adherence, and work productivity and limitations. DESIGN, SETTING, AND PARTICIPANTS This 1-year, single-center, open-label, parallel-group, real-world, randomized clinical trial was conducted at the Cleveland Clinic's Endocrinology and Metabolism Institute in Cleveland, Ohio, from January 7, 2019, to May 22, 2020. Participants were adults with obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥30) enrolled in the Cleveland Clinic Employee Health Plan. INTERVENTIONS In total, 200 participants were randomized 1:1, 100 participants to WMP combined with an AOM (WMP+Rx), and 100 participants to WMP alone. The WMP was the Cleveland Clinic Endocrinology and Metabolism Institute's employer-based integrated medical WMP implemented through monthly multidisciplinary shared medical appointments. Participants in the WMP+Rx group initiated treatment with 1 of 5 US Food and Drug Administration-approved medications for chronic weight management (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide, 3.0 mg) according to standard clinical practice. MAIN OUTCOMES AND MEASURES The primary end point was the percentage change in body weight from baseline to month 12. RESULTS The 200 participants were predominately (177 of 200 [88.5%]) women, had a mean (SD) age of 50.0 (10.3) years, and a mean (SD) baseline weight of 105.0 (19.0) kg. For the primary intention-to-treat estimand, the estimated mean (SE) weight loss was -7.7% (0.7%) for the WMP+Rx group vs -4.2% (0.7%) for the WMP group, with an estimated treatment difference of -3.5% (95% CI, -5.5% to -1.5%) (P < .001). The estimated percentage of participants achieving at least 5% weight loss was 62.5% for WMP+Rx vs 44.8% for WMP (P = .02). The rate of attendance at shared medical appointments was higher for the WMP+Rx group than for the WMP group. No meaningful differences in patient-reported work productivity or limitation measures were observed. CONCLUSIONS AND RELEVANCE Clinically meaningful superior mean weight loss was achieved when access to AOMs was provided in the real-world setting of an employer-based WMP, compared with the WMP alone. Such results may inform employer decisions regarding AOM coverage and guide best practices for comprehensive, interdisciplinary employer-based WMPs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03799198.
Collapse
Affiliation(s)
- Kevin M. Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Bruce Rogen
- Cleveland Clinic Employee Health Plan, Cleveland, Ohio
| | | | - Elena Borukh
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - James B. Young
- Cleveland Clinic Executive Administration, Cleveland, Ohio
| | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
9
|
Beidelschies M, Alejandro-Rodriguez M, Guo N, Postan A, Jones T, Bradley E, Hyman M, Rothberg MB. Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study. BMJ Open 2021; 11:e048294. [PMID: 33849860 PMCID: PMC8051390 DOI: 10.1136/bmjopen-2020-048294] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments. DESIGN A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments. SETTING A single-centre study performed at Cleveland Clinic Center for Functional Medicine. PARTICIPANTS A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost. RESULTS Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments. CONCLUSION SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.
Collapse
Affiliation(s)
| | | | - Ning Guo
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna Postan
- Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tawny Jones
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Bradley
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Hyman
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | |
Collapse
|
10
|
Lopes MS, Freitas PP, Carvalho MCR, Ferreira NL, Campos SF, Menezes MC, Lopes ACS. Challenges for obesity management in a unified health system: the view of health professionals. Fam Pract 2021; 38:4-10. [PMID: 33128071 DOI: 10.1093/fampra/cmaa117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals. OBJECTIVE To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals. METHODS An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process. RESULTS We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support. CONCLUSION Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.
Collapse
Affiliation(s)
- Mariana S Lopes
- Department of Nutrition, Universidade Federal de Minas Gerais, Nurse School, Research Group on Nutrition Interventions, Alfredo Balena, Belo Horizonte, Brazil
| | - Patrícia P Freitas
- Department of Nutrition, Universidade Federal de Minas Gerais, Nurse School, Research Group on Nutrition Interventions, Alfredo Balena, Belo Horizonte, Brazil
| | - Maria C R Carvalho
- Department of Nutrition, Universidade Federal de Minas Gerais, Nurse School, Research Group on Nutrition Interventions, Alfredo Balena, Belo Horizonte, Brazil
| | - Nathália L Ferreira
- Pitágoras College, Research Group on Nutrition Interventions, Afonso Pena, Belo Horizonte, Brazil
| | - Suellen F Campos
- Department of Nutrition, Universidade Federal de Minas Gerais, Nurse School, Research Group on Nutrition Interventions, Alfredo Balena, Belo Horizonte, Brazil
| | - Mariana C Menezes
- Department of Clinical and Social Nutrition, Univerisdade Federal de Ouro Preto, Nutrition School, Research Group on Nutrition Interventions, Dois, Ouro Preto, Brazil
| | - Aline C S Lopes
- Department of Nutrition, Universidade Federal de Minas Gerais, Nurse School, Research Group on Nutrition Interventions, Alfredo Balena, Belo Horizonte, Brazil
| |
Collapse
|