Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial
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 di...
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| Published in | Obesity (Silver Spring, Md.) Vol. 26; no. 10; pp. 1532 - 1538 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.10.2018
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| Subjects | |
| Online Access | Get full text |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. 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. To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. 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. 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. 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. 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. OBJECTIVETo examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment.METHODSPCPs 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.RESULTSEighty 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.CONCLUSIONSPCPs initially overvalued exercise and undervalued weight-loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight-loss medications. |
| Author | Gudzune, Kimberly Bessesen, Daniel Saxon, David Tsai, Adam Clark, Jeanne Iwamoto, Sean Speer, Rebecca Leister, Erin Bleich, Sara Heyn, Hilde Kealey, Elizabeth Juarez‐Colunga, Elizabeth |
| AuthorAffiliation | 1 Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA 5 Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA 9 Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA 3 Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA 2 Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA 10 Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA 11 Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA 7 Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA 8 Anschutz Health and Wellness Cent |
| AuthorAffiliation_xml | – name: 5 Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA – name: 8 Anschutz Health and Wellness Center, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA – name: 3 Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA – name: 4 Department of Internal Medicine and Metabolic-Surgical Weight Management, Kaiser Permanente Colorado, Denver, CO, USA – name: 7 Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA – name: 6 Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA – name: 10 Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA – name: 1 Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA – name: 11 Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA – name: 9 Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA – name: 2 Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30257072$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s11606_020_06548_w crossref_primary_10_1177_21501327211013292 crossref_primary_10_1016_j_mayocp_2019_09_019 crossref_primary_10_1177_2150132721996283 crossref_primary_10_1136_bmj_2022_072686 crossref_primary_10_1002_oby_22581 crossref_primary_10_1002_oby_22628 crossref_primary_10_1038_s41366_019_0453_6 |
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| Copyright | 2018 The Obesity Society 2018 The Obesity Society. Copyright Blackwell Publishing Ltd. Oct 2018 |
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| Notes | ClincalTrials.gov identifier NCT01922934. DB serves on a Data Safety Monitoring Committee for Enteromedics, Inc. The other authors declared no conflict of interest. Clinical trial registration Disclosure Funding agencies Research reported in this work was primarily funded through a Patient‐Centered Outcomes Research Institute (PCORI) Award (IH‐12‐11‐4571). Support was also provided by P30 DK048520 and T32 DK007446 (DS and SI). DS was also supported in part by NIH/NCATS Colorado CTSA Grant Number UL1 TR001082 and the VA Advanced Fellowship Program in Health Services Research and Development. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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| References | 2015; 162 2015; 34 2013; 26 2015; 38 2012 2000; 9 2015; 33 2009; 374 2014; 46 2010; 80 2014; 22 2012; 31 2014; 311 2009; 28 2016; 4 2018; 6 2007; 29 2013; 37 2014; 4 2016; 2 2013; 56 2013; 51 2004; 59 2004; 12 2000; 160 2011; 41 2002; 346 2003; 27 2014 2007; 3 2007; 22 2011; 343 2011; 123 2012; 42 2016; 24 2009; 17 2014; 97 Khandalavala BN (e_1_2_6_11_1) 2014; 46 e_1_2_6_32_1 e_1_2_6_10_1 e_1_2_6_31_1 e_1_2_6_30_1 e_1_2_6_19_1 e_1_2_6_13_1 e_1_2_6_36_1 e_1_2_6_35_1 e_1_2_6_34_1 Ruelaz AR (e_1_2_6_39_1) 2007; 22 e_1_2_6_12_1 e_1_2_6_33_1 e_1_2_6_17_1 e_1_2_6_18_1 e_1_2_6_15_1 e_1_2_6_38_1 e_1_2_6_16_1 e_1_2_6_37_1 e_1_2_6_42_1 e_1_2_6_43_1 e_1_2_6_21_1 e_1_2_6_20_1 e_1_2_6_41_1 e_1_2_6_40_1 e_1_2_6_9_1 e_1_2_6_8_1 e_1_2_6_5_1 e_1_2_6_4_1 e_1_2_6_7_1 e_1_2_6_6_1 e_1_2_6_25_1 e_1_2_6_24_1 e_1_2_6_3_1 Jensen MD (e_1_2_6_14_1) 2014; 22 e_1_2_6_23_1 e_1_2_6_2_1 e_1_2_6_22_1 e_1_2_6_29_1 e_1_2_6_44_1 e_1_2_6_28_1 e_1_2_6_45_1 e_1_2_6_27_1 e_1_2_6_46_1 e_1_2_6_26_1 |
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| Snippet | Objective
To examine the impact of a 1‐year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment.
Methods
PCPs from four... To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. PCPs from four intervention clinics... Objective: To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. Methods: PCPs from four... OBJECTIVETo examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment.METHODSPCPs from four... |
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| SubjectTerms | 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 |
| Title | Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial |
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