Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial

• Published in: Obesity (Silver Spring, Md.) Vol. 26; no. 10; pp. 1532 - 1538
• Main Authors: Iwamoto, Sean, Saxon, David, Tsai, Adam, Leister, Erin, Speer, Rebecca, Heyn, Hilde, Kealey, Elizabeth, Juarez‐Colunga, Elizabeth, Gudzune, Kimberly, Bleich, Sara, Clark, Jeanne, Bessesen, Daniel
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.10.2018
• Subjects: Clinical trials; Clinics; Counseling; Diabetes; Disease control; Disease prevention; Drug therapy; Exercise; Gastrointestinal surgery; Intervention; Meals; Obesity; Patients; Physical fitness; Physicians; Polls & surveys; Prevention programs; Primary care; Systematic review; Weight control; United States > US
• ISSN: 1930-7381; 1930-739X
• DOI: 10.1002/oby.22223

Objective To examine the impact of a 1‐year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. Methods PCPs from four intervention clinics (PCP‐I) and five control clinics (PCP‐C) completed pre‐ and postintervention surveys on weight‐loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP‐I received patient updates and education about obesity management. Results Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP‐C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP‐C: 8.37 [1.24]; P = 0.8; pre/post PCP‐I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP‐I (pre/post PCP‐C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP‐I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP‐I (pre/post PCP‐C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP‐I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP‐C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP‐I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP‐C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP‐I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP‐I. Conclusions PCPs initially overvalued exercise and undervalued weight‐loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight‐loss medications.