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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Law LH, Wilson DK, St George SM, Kitzman H, Kipp CJ. Families Improving Together (FIT) for weight loss: a resource for translation of a positive climate-based intervention into community settings. Transl Behav Med 2021; 10:1064-1069. [PMID: 31167022 DOI: 10.1093/tbm/ibz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Climate-based weight loss interventions, or those that foster a nurturing family environment, address important ecological influences typically ignored by the traditional biomedical treatments. Promoting a climate characterized by positive communication, autonomy support, and parental warmth supports adolescents in making healthy behavioral changes. In addition, encouraging these skills within the family may have additional benefits of improved family functioning and other mental and physical health outcomes. Although several programs have identified essential elements and established the evidence base for the efficacy of these interventions, few have offered resources for the translation of these constructs from theoretical concepts to tangible practice. This paper provides strategies and resources utilized in the Families Improving Together (FIT) for weight loss randomized controlled trial to create a warm, supportive climate characterized by positive communication within the parent-child relationship. Detailed descriptions of how Project FIT emphasized these constructs through facilitator training, intervention curriculum, and process evaluation are provided as a resource for clinical and community interventions. Researchers are encouraged to provide resources to promote translation of evidence-based interventions for programs aiming to utilize a positive climate-based family approach for lifestyle modification.
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Affiliation(s)
- Lauren H Law
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Colby J Kipp
- Department of Psychology, University of South Carolina, Columbia, SC
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A Strategic Plan for Strengthening America's Families: A Brief from the Coalition of Behavioral Science Organizations. Clin Child Fam Psychol Rev 2021; 23:153-175. [PMID: 32347415 PMCID: PMC7186188 DOI: 10.1007/s10567-020-00318-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America’s children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.
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Jacobs M, Harris J, Craven K, Sastre L. Sharing the 'weight' of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients. Fam Pract 2021; 38:18-24. [PMID: 32076702 DOI: 10.1093/fampra/cmaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes. OBJECTIVES The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors. METHODS A case-control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2. RESULTS Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time. CONCLUSIONS Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services and Information Management, East Carolina University, Greenville, SC, USA
| | - Jordan Harris
- Department of Nutrition Science, East Carolina University, Greenville, SC, USA
| | - Kay Craven
- Department of Family Medicine, East Carolina University, Greenville, SC, USA
| | - Lauren Sastre
- Department of Nutrition Science, East Carolina University, Greenville, SC, USA
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Parent Perspectives on Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2020; 71:744-748. [PMID: 32910623 DOI: 10.1097/mpg.0000000000002847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Exclusive enteral nutrition (EEN) is infrequently used in the United States but is an effective treatment for pediatric Crohn disease (CD). Limited data exists regarding patient and parent perspectives on this treatment modality. The aim of this study was to determine parent and provider perspectives regarding EEN and understand parent-cited barriers to its use. METHODS We surveyed the parents/guardians of children ages 1 through 17 with CD in our institution regarding EEN. Healthcare provider perspectives regarding reason for stopping EEN and those cited by survey respondents were compared using retrospective chart review. RESULTS One hundred fifteen (62.5%) out of 184 recipients responded to the survey. Ninety percentage of respondents had heard of EEN but of these, 26% had not discussed it with their gastroenterologist. Thirty-eight patients (33%) were treated in the past and 15 (13%) were currently on EEN. Common barriers cited by current EEN users were cost/finances and difficult social situations. Of the children who stopped EEN, most did so as parents felt it was not working (n = 14, 37%). In these cases, their primary gastroenterologist cited treatment failure for 4 cases and nonadherence for 6. CONCLUSIONS Despite the efficacy of EEN and interest in dietary treatments by patients with CD, there are many barriers surrounding effective communication and successful implementation of dietary therapies. Future research is needed regarding patient-physician communication, cost mitigation, and coping with the social limitations of dietary therapies.
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Stoutenberg M, Powell BJ, Busignani PJ, Bowersock AH, Pojednic R. Identifying Key Physical Activity Categories and Topics to Include in Health Professional Training Programs. TEACHING AND LEARNING IN MEDICINE 2020; 32:362-370. [PMID: 32107937 DOI: 10.1080/10401334.2020.1730183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Healthcare is an important sector in promoting physical activity (PA). However, few health professional training programs include PA, nor does standardized guidance exist on implementing it in the curriculum. This study aimed to consolidate health professional expert opinion on key PA categories and topics that should be included in the curriculum of health professional training programs. Approach: A three-round, modified e-Delphi process examined the opinions of 73 experts from seven health professions (clinical nutrition, exercise physiology, medicine, nursing, occupational therapy, physical therapy, physician assistants). In Round 1, panelists reported importance, ranked, and scored five broad PA categories, and responded to open-ended prompts for additional categories. In Round 2, panelists received summary feedback, re-ranked and re-scored PA categories, and suggested key PA topics within the five categories. In the final round, panelists viewed, ranked, and scored the PA topics. Findings: Expert panelists felt that all PA categories were important, with Health Behavior Change ranking the highest (98.7%) followed by Cellular and Systemic Implications of Exercise, Clinical Exercise Physiology, and PA and Public Health. The Administrative Aspects of Integrating PA into Health Systems ranked least important (48.0%). A consensus on the key PA categories was considered reached after two rounds. Five to eight specific PA topics were generated within each PA category and ranked in order of importance. Insights: These findings highlight several key PA categories and topics that can serve as a foundation for a diverse number of health professional training programs.
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Affiliation(s)
- Mark Stoutenberg
- Department of Health & Human Performance, University of Tennessee Chattanooga, Chattanooga, Tennessee, USA
| | - Byron J Powell
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | | | - Allison H Bowersock
- Department of Basic Sciences, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Rachele Pojednic
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, Massachusetts, USA
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Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity. J Am Assoc Nurse Pract 2020; 31:502-510. [PMID: 30829975 DOI: 10.1097/jxx.0000000000000169] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting. METHODS A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire-Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed. CONCLUSIONS More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74). IMPLICATIONS FOR PRACTICE The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.
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Pascual V, Perez Martinez P, Fernández JM, Solá R, Pallarés V, Romero Secín A, Pérez Jiménez F, Ros E. [SEA/SEMERGEN consensus document 2019: Dietary recommendations in the prevention of cardiovascular disease]. Semergen 2019; 45:333-348. [PMID: 31164311 DOI: 10.1016/j.semerg.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
The current paradigm in the nutrition sciences states that the basic nutritional unit is not the nutrients, but the foods that contain them (oils, nuts, dairy products, eggs, red or processed meats, etc.). These act as a food matrix in which the different nutrients synergistically or antagonistically modulate their effects on the various metabolic pathways determining health and disease. Food is not based on nutrients or isolated foods but on complex mixtures of one and the other that are part of a specific food pattern, a concept that has been targeted as the most pertinent to evaluate the associations between nutrition and health or disease. This document presents a summary of the available evidence on the relationship between different foods and cardiovascular health, and offers simple recommendations to be implemented in the dietary advice offered by the health professional.
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Affiliation(s)
- Vicente Pascual
- Centro de Salud Palleter, Castellón, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA); Grupo de Trabajo Nutrición de SEMERGEN; Universidad CEU-Cardenal Herrera, Castellón, España.
| | - Pablo Perez Martinez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - José Manuel Fernández
- Centro de Salud de Valga, Valga, Pontevedra, España; Grupo de Trabajo Nutrición de SEMERGEN
| | - Rosa Solá
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Hospital Universitario Sant Joan, EURECAT-Technological Center of Nutrition and Health (CTNS), Facultad de Medicina y Ciencias de la Salud, Universidad Rovira i Virgili, Reus, Tarragona, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Grupo de Trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN; Departamento de Medicina, Universitat Jaume I, Castellón, España
| | - Anny Romero Secín
- Centro de Salud de Tineo, Tineo, Asturias, España; Grupo de Trabajo Nutrición de SEMERGEN
| | - Francisco Pérez Jiménez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universidad de Barcelona, Barcelona, España; Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
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SEA/SEMERGEN consensus document 2019: Dietary recommendations in the prevention of cardiovascular disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:186-201. [PMID: 30910237 DOI: 10.1016/j.arteri.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 01/15/2023]
Abstract
The current paradigm in the nutrition sciences states that the basic nutritional unit is not the nutrients, but the foods that contain them (oils, nuts, dairy products, eggs, red or processed meats, etc.). These act as a food matrix in which the different nutrients synergistically or antagonistically modulate their effects on the various metabolic pathways determining health and disease. Food is not based on nutrients or isolated foods but on complex mixtures of one and the other that are part of a specific food pattern, a concept that has been targeted as the most pertinent to evaluate the associations between nutrition and health or disease. This document presents a summary of the available evidence on the relationship between different foods and cardiovascular health, and offers simple recommendations to be implemented in the dietary advice offered by the health professional.
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Bright D, O'Hare K, Beesley R, Tapp H. Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity. Exp Biol Med (Maywood) 2019; 244:183-192. [PMID: 30661395 DOI: 10.1177/1535370219825639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.
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Affiliation(s)
- Dellyse Bright
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Katherine O'Hare
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Rebecca Beesley
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
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