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Sillcox R, Blaustein M, Khandelwal S, Bryant MK, Zhu J, Chen JY. Telemedicine Use Decreases the Carbon Footprint of the Bariatric Surgery Preoperative Evaluation. Obes Surg 2023; 33:2527-2532. [PMID: 37407773 DOI: 10.1007/s11695-023-06721-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Healthcare-associated activity accounts for 10% of the United States' carbon dioxide (CO2) emissions. Using telemedicine for bariatric surgery evaluations decreases emissions and reduces patient burden during the multiple required interdisciplinary visits. After adopting telemedicine during COVID, our clinic continues to utilize telemedicine for preoperative bariatric evaluations. We evaluated the reduced environmental impact associated with this practice. METHODS A retrospective review of all new evaluations for vertical sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB) from 2019 and 2021 was conducted. The 2019 year represents pre-pandemic, in-person evaluations and 2021 represents telemedicine evaluations during the COVID pandemic. Carbon emissions were calculated using the Environmental Protection Agency's (EPA's) validated formula of 404g CO2 per car-mile. Preoperative evaluation time was calculated from the initial clinic visit to the operation date. RESULTS There were 51 patients in the 2019 cohort and 55 patients in the 2021 cohort. In the 2019 in-person cohort, there was significantly more kg of estimated CO2 emitted (10,225 vs. 2011.4, p<.001) compared to the 2021 cohort. For time required to complete the preoperative workup, there was no statistically significant difference between the two groups (162 days vs. 193 days, p=.226). The attrition rate was lower in the 2021 cohort (22.22% v. 35.9%, p<.001). CONCLUSIONS Implementation of telemedicine for bariatric preoperative evaluations reduced patient travel, carbon emissions, and improved attrition rate. We encourage bariatric providers to use telemedicine as we believe this eases patient burdens and, with wider adoption, could significantly reduce our carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA.
| | - Megan Blaustein
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Saurabh Khandelwal
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Judy Y Chen
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
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Funk LM, Alagoz E, Murtha JA, Breuer CR, Pati B, Eierman L, Jawara D, Farrar-Edwards D, Voils CI. Socioeconomic disparities and bariatric surgery outcomes: A qualitative analysis. Am J Surg 2023; 225:609-614. [PMID: 36180301 PMCID: PMC10033325 DOI: 10.1016/j.amjsurg.2022.09.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Disparities in socioeconomic status (SES) have been associated with less weight loss after bariatric surgery. The objective of this study was to identify socioeconomic barriers to weight loss after bariatric surgery. METHODS We performed semi-structured interviews with bariatric surgery patients and providers from April-November 2020. Participants were asked to describe their post-operative experiences regarding dietary habits, physical activity, and follow-up care. Interview data were coded using Directed Content Analysis based on domains in Andersen's Behavioral Model of Health Services Use and Torain's Surgical Disparities Model. RESULTS 24 patients (median of 4.1 years post-operatively; mean age 50.6 ± 10.7 years; 12 bypass and 12 sleeve; 83% female) and 21 providers (6 bariatric surgeons, 5 registered dietitians, 4 health psychologists, and 6 primary care providers) were interviewed. Barriers to weight loss included: 1) challenging employment situations; 2) limited income; 3) unreliable transportation; 4) unsafe/inconvenient neighborhoods; and 5) limited health literacy. CONCLUSIONS Interventions targeting socioeconomic barriers to weight loss are needed to support patients, particularly those who are socioeconomically disadvantaged.
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Affiliation(s)
- Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA; William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, USA.
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | - Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | - Bhabna Pati
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsey Eierman
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | - Dawda Jawara
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA
| | | | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI, USA; William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, USA
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3
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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4
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, De Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022; 18:1345-56. [PMID: 36280539 DOI: 10.1016/j.soard.2022.08.013] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.
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5
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Stoltz DJ, Liebert CA, Seib CD, Bruun A, Arnow KD, Barreto NB, Pratt JS, Eisenberg D. Preventive Health Screening in Veterans Undergoing Bariatric Surgery. Am J Prev Med 2022; 63:979-986. [PMID: 36100538 DOI: 10.1016/j.amepre.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Individuals with obesity are vulnerable to low rates of preventive health screening. Veterans with obesity seeking bariatric surgery are also hypothesized to have gaps in preventive health screening. Evaluation in a multidisciplinary bariatric surgery clinic is a point of interaction with the healthcare system that could facilitate improvements in screening. METHODS This is a retrospective cohort study of 381 consecutive patients undergoing bariatric surgery at a Veterans Affairs Hospital from January 2010 to October 2021. Age- and sex-appropriate health screening rates were determined at initial referral to a multidisciplinary bariatric surgery clinic and at the time of surgery. Rates of guideline concordance at both time points were compared using McNemar's test. Univariate and multivariate analyses were performed to identify the risk factors for nonconcordance. RESULTS Concordance with all recommended screening was low at initial referral and significantly improved by time of surgery (39.1%‒63.8%; p<0.001). Screening rates significantly improved for HIV (p<0.001), cervical cancer (p=0.03), and colon cancer (p<0.001). Increases in BMI (p=0.005) and the number of indicated screening tests (p=0.029) were associated with reduced odds of concordance at initial referral. Smoking history (p=0.012) and increasing distance to the nearest Veterans Affairs Medical Center (p=0.039) were associated with reduced odds of change from nonconcordance at initial referral to concordance at the time of surgery. CONCLUSIONS Rates of preventive health screening in Veterans with obesity are low. A multidisciplinary bariatric surgery clinic is an opportunity to improve preventive health screening in Veterans referred for bariatric surgery.
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Affiliation(s)
- Daniel J Stoltz
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Cara A Liebert
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Carolyn D Seib
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California; Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Aida Bruun
- Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Katherine D Arnow
- Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Nicolas B Barreto
- Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Janey S Pratt
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California; Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
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6
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Mills J, Liebert C, Pratt J, Earley M, Eisenberg D. Complete Telehealth for Multidisciplinary Preoperative Workup Does Not Delay Time to Metabolic and Bariatric Surgery: a Pilot Study. Obes Surg. [PMID: 36114438 PMCID: PMC9483527 DOI: 10.1007/s11695-022-06233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/07/2022]
Abstract
Purpose The COVID-19 pandemic accelerated implementation of telehealth throughout the US healthcare system. At our institution, we converted a fully integrated multidisciplinary bariatric clinic from face-to-face visits to entirely telehealth video/telephone visits. We hypothesized telehealth would increase the number of provider/patient encounters and therefore delay time to surgery. Methods This is a retrospective review of consecutive patients who underwent total telehealth preoperative workup. Demographics, comorbidities, and surgical characteristics were compared to the same number of consecutive patients who underwent a face-to-face approach 12 months prior, using a Wilcoxon test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Differences between time and surgery were compared using inverse probability of treatment-weighted estimates and number of preoperative visits using Poisson regression with distance to hospital as a confounder. Noninferiority margin for time to surgery was set to 60 days, and the number of visits was set to 2 visits. Results Between March of 2020 and December of 2021, 36 patients had total telehealth workup, and were compared to 36 patients in the traditional group. Age, sex, body mass index, and comorbidities did not differ between groups. The average number of days to surgery was 121.1 days shorter in the telehealth group (90% bootstrap CI [− 160.4, − 81.8]). Estimated shift in the total number of visits was additional .76 visits in the traditional group (90% CI [.64, .91). Conclusions The total telehealth approach to preoperative bariatric multidisciplinary workup did not delay surgery and decreased number of total outpatient visits and time to surgery. Graphical abstract ![]()
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7
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Funk LM, Alagoz E, Jolles SA, Shea GE, Gunter RL, Raffa SD, Voils CI. A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration. Ann Surg 2022; 275:e181-e188. [PMID: 32886462 PMCID: PMC7674184 DOI: 10.1097/sla.0000000000003982] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. SUMMARY OF BACKGROUND DATA Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration. METHODS We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use. RESULTS Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time. CONCLUSIONS Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.
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Affiliation(s)
- Luke M. Funk
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sally A. Jolles
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Grace E. Shea
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rebecca L. Gunter
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Susan D. Raffa
- Department of Veterans Affairs, National Center for Health Promotion and Disease Prevention, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Corrine I. Voils
- William S. Middleton VA Memorial Hospital, Madison, WI
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, Madison, WI
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8
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Lohnberg JA, Salcido L, Frayne S, Mahtani N, Bates C, Hauser ME, Breland JY. Rapid conversion to virtual obesity care in COVID-19: Impact on patient care, interdisciplinary collaboration, and training. Obes Sci Pract 2021; 8:131-136. [PMID: 34540265 PMCID: PMC8441727 DOI: 10.1002/osp4.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Objective The COVID‐19 pandemic presents challenges to maintaining interdisciplinary collaboration while transitioning care to telehealth environments. This paper describes how an intensive weight management clinic rapidly transitioned from in‐person only to a telehealth environment. Method As a program evaluation project, changes to clinic procedures were tracked on a weekly basis. Patients were invited to complete phone surveys after clinic appointments from 1 May 2020 to 31 July 2020. The survey included 12 items rated on a 5‐point scale (“strongly disagree” to “strongly agree”). Results Adaptations included converting team meetings and clinical training to phone/video platforms and transferring a complex patient tracking system to an interactive virtual format. Fifty‐eight patients completed phone surveys (81% response rate). All “agreed” or “strongly agreed” that they were satisfied with telehealth care; 51% “agreed” or “strongly agreed” that telephone visits were as good as in‐person visits; and 53% preferred phone appointments even after pandemic restrictions are eased. Conclusions It is feasible to rapidly transition to a telehealth clinic when supported by infrastructure and resources of a national, integrated healthcare system. Patient preferences include access to both telehealth and in‐person services. A blended telehealth/in‐person model that maintains interdisciplinary collaboration and training is necessary even after the COVID‐19 pandemic.
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Affiliation(s)
- Jessica A Lohnberg
- Psychology Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA.,Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA
| | - Lianne Salcido
- Psychology Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i) VA Palo Alto Health Care System Menlo Park California USA.,Division of Primary Care and Population Health Stanford University Stanford California USA
| | - Naina Mahtani
- Mental Health Service San Francisco VA Health Care System San Francisco California USA
| | - Cheryl Bates
- Medical Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA
| | - Michelle E Hauser
- Division of Primary Care and Population Health Stanford University Stanford California USA.,Medical Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA.,Minimally Invasive & Bariatric Surgery Division of General Surgery Department of Surgery Stanford University School of Medicine Stanford California USA.,Department of Medicine Adult Primary Care-Fair Oaks Health Center San Mateo County Health System Redwood City California USA
| | - Jessica Y Breland
- Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA.,VA HSR&D Center for Innovation to Implementation (Ci2i) VA Palo Alto Health Care System Menlo Park California USA
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Abstract
PURPOSE OF REVIEW Eating disorders (EDs) and overweight/obesity (OW/OB) have a significant impact on veterans. This review highlights current research on EDs and OW/OB in this population. RECENT FINDINGS Prevalence estimates for both EDs and OW/OB among veterans remain consistent with and possibly higher than those in the general population. Both diagnoses share multiple risk factors, including trauma history, and mental health comorbidities. Although weight loss treatments have been fairly well studied among veteran samples, there are no published investigations on psychotherapies for EDs in this population. The Veterans Healthcare Administration is working to train providers in ED treatments. VHA treatments for OW/OB show some benefits and areas for improvement. Areas for future research include structured assessments for EDs and disordered eating behaviors in veterans to clarify prevalence estimates. There is a need for interventions that consider common mechanisms for ED and OW/OB, and there is a need for more research on the associations between different types of trauma and ED/OW/OB in veterans.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Sabrina Hardin
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Rachel Zelkowitz
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Karen Mitchell
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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10
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Kitamura R, Chen R, Trickey A, Eisenberg D. Positive and Negative Independent Predictive Factors of Weight Loss After Bariatric Surgery in a Veteran Population. Obes Surg 2020; 30:2124-2130. [DOI: 10.1007/s11695-020-04428-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Voils CI, Adler R, Strawbridge E, Grubber J, Allen KD, Olsen MK, McVay MA, Raghavan S, Raffa SD, Funk LM. Early-phase study of a telephone-based intervention to reduce weight regain among bariatric surgery patients. Health Psychol 2020; 39:391-402. [PMID: 31999175 DOI: 10.1037/hea0000835] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study describes early-phase development of a behavioral intervention to reduce weight regain following bariatric surgery. We utilized the Obesity-Related Behavioral Intervention Trials model to guide intervention development and evaluation. We sought to establish recruitment, retention, and fidelity monitoring procedures; evaluate feasibility of utilizing weight from the electronic medical record (EMR) as an outcome; observe improvement in behavioral risk factors; and evaluate treatment acceptability. METHOD The intervention comprised 4 weekly telephone calls addressing behavior change strategies for diet, physical activity, and nutrition supplement adherence and 5 biweekly calls addressing weight loss maintenance constructs. Veterans (N = 33) who received bariatric surgery 9-15 months prior consented to a 16-week, pre-post study. Self-reported outcomes were obtained by telephone at baseline and 16 weeks. Clinic weights were obtained from the EMR 6 months pre- and postconsent. Qualitative interviews were conducted at 16 weeks to evaluate treatment acceptability. We aimed to achieve a recruitment rate of ≥ 25% and retention rate of ≥ 80%, and have ≥ 50% of participants regain < 3% of their baseline weight. RESULTS Results supported the feasibility of recruiting (48%) and retaining participants (93% provided survey data; 100% had EMR weight). Pre-post changes in weight (73% with < 3% weight regain) and physical activity (Cohen's ds 0.38 to 0.52) supported the potential for the intervention to yield clinically significant results. Intervention adherence (mean 7.8 calls of 9 received) and positive feedback from interviews supported treatment acceptability. CONCLUSIONS The intervention should be evaluated in an adequately powered randomized controlled trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luke M Funk
- William S. Middleton Memorial Veterans Hospital
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12
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Affiliation(s)
- Gao Linda Chen
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Eric Kubat
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Surgical Service, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
| | - Dan Eisenberg
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Surgical Service, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
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13
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Croker A, Brown L, Little A, Squires K, Crowley E. Developing and maintaining collaborative practice: Exploring perspectives from dietetics and speech pathology about ‘what works well’. Nutr Diet 2018; 76:28-37. [DOI: 10.1111/1747-0080.12506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Croker
- The University of Newcastle Department of Rural Health; Tamworth New South Wales Australia
| | - Leanne Brown
- The University of Newcastle Department of Rural Health; Tamworth New South Wales Australia
| | - Alexandra Little
- The University of Newcastle Department of Rural Health; Tamworth New South Wales Australia
| | - Kelly Squires
- The University of Newcastle Department of Rural Health; Tamworth New South Wales Australia
| | - Elesa Crowley
- The University of Newcastle Department of Rural Health; Tamworth New South Wales Australia
- Hunter New England Local Health District; Tamworth New South Wales Australia
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Grace N, Kubat E, Eisenberg D. An Integrated, Collaborative Multidisciplinary Clinic Improves 12-Month Follow-Up After Bariatric Surgery at a Single Veterans Affairs Medical Center. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Nalani Grace
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eric Kubat
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Dan Eisenberg
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
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