Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults

Integration of the 5A's Framework in Research on Obesity and Weight Counseling: Systematic Review of Literature

The 5A's Framework (Assess, Advise, Assist, Agree, and Arrange) has been recommended as a practice guide for obesity counseling. Its integration in research, however, is not well known. This systematic review was to find how the 5A's Framework was integrated in research on obesity and weight counseling. Methods: A systematic search of four databases was conducted combining two concepts: "5 A's Framework" and "obesity, body size, dieting/eating, exercise, weight loss." Inclusion criteria were quantitative studies with the 5A's Framework as a singular intervention or combined with others to influence patients' healthy eating, physical activity, and weight outcomes or care providers' counseling behaviors. Twenty-two studies were included in the final analysis. Results: Most studies were conducted in the primary care setting. The 5A's Framework was (1) integrated in training interventions as formal medical curricular and on-the-job education workshops to influence obesity/weight counseling skills, (2) utilized to develop assessment tools to evaluate counseling behaviors, and (3) combined with behavior change strategies to impact the patient's weight management behaviors and outcomes. Conclusion: The integration of the 5A's Framework in obesity and weight counseling research is wide-ranging. The findings have implications for clinicians to use the framework to better obesity/weight counseling.

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial

BACKGROUND

The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network.

METHODS

In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models.

RESULTS

More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up.

CONCLUSION

To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.

TRIAL REGISTRATION

The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).

Correlates of Self-Care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure

PURPOSE

The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).

METHOD

Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.

RESULT

Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.

CONCLUSION

Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.

The association between the receipt of primary care clinician provision of preventive care and short term health behaviour change

Primary healthcare services are recommended to provide preventive care to address chronic disease risk behaviours. However, all care elements are infrequently provided, and there is a need to understand the impact of partial care provision on behaviour change. This study examined the association between variable levels of preventive care receipt from primary care clinicians on short-term behaviour change for four risk behaviours. A survey was undertaken with 5639 Australian community health service clients (2009-2014). Clients self-reported: engagement in risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, physical inactivity) in the month prior to and four week post their community health service appointment; receipt of preventive care during appointments (assessment, advice, referral/follow-up) for each behaviour. Univariate regression models explored the association between change in risk status and preventive care received. The odds of behaviour change for those receiving all three care elements was significant for all behaviours, compared to no care, ranging from 2.02 (alcohol consumption, 95% CI 1.16-3.49) to 4.17 (inadequate fruit and/or vegetable consumption, 95% CI 2.91-5.96). Receipt of both assessment and advice increased the odds of behaviour change, compared to no care, for all behaviours except smoking, ranging from 2.32 (physical inactivity, 95% CI 1.60-3.35) to 2.83 (alcohol consumption, 95% CI 1.84-4.33). Receipt of 'assessment only' increased the odds of behaviour change, compared to no care, for inadequate fruit and/or vegetable consumption (OR = 2.40, 95% CI 1.60-3.59) and physical inactivity (OR = 2.81, 95% CI 1.89-4.17). Results highlight the importance of primary care clinicians providing best practice preventive care to maximise client behaviour change.

General practitioner referrals to exercise physiologists during routine practice: A prospective study

OBJECTIVES

Physical activity is essential in the primary and secondary prevention of several chronic diseases and should be a standard component of clinical care. The aims of this study were to examine the trends and characteristics of referrals to exercise physiologists in routine care in a nationally representative sample of general practitioners (GPs) in Australia.

DESIGN

This prospective study was an analysis of Bettering the Evaluation and Care of Health (BEACH) GP data from April 2009 to March 2016.

METHODS

In total, each of 6827 randomly sampled GPs recorded details of 100 consecutive encounters (N=682,700). The rate of exercise physiologist referrals was calculated by patient and GP characteristics.

RESULTS

Over the study period, the rate at which GPs referred their patients significantly increased from 0.38 to 1.44 per 1000 encounters. Patients aged 45-64 years were most likely to be referred (1.32 per 1000 encounters). Patients from non-English-speaking backgrounds were referred at less than half the rate (0.41 per 1000) of those from English speaking backgrounds (0.96). Female GPs referred patients (1.27 per 1000 encounters) twice as often as male GPs (0.64). One-third (35.3%) of GP referrals were made for problems relating to the endocrine, nutritional and metabolic systems (e.g., obesity, diabetes mellitus); only 1.6% of referrals were made for mental health conditions.

CONCLUSIONS

Although increasing, the rate of GP referral to exercise physiologists was low and associated with patient and GP characteristics. Education of GPs about the role of exercise physiologists in the prevention and management of chronic disease is needed.

Physical activity counseling in primary care and family medicine residency training: a systematic review

BACKGROUND

Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs.

METHODS

The authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review.

RESULTS

Based on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling.

CONCLUSIONS

This systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.