Practical Approaches to Obesity Care and Chronic Illness In Busy Clinical Settings: Three Key Ingredients

Jaan Sidorov

First posted 9/27/11 on the Disease Management Care Blog

If anything is true about the population health management service providers, they are constantly looking for better ways to fit their programs into busy clinical settings.

That’s why this article on New and Emerging Weight Management Strategies for Busy Ambulatory Settings, courtesy of the American Heart Association, should be “must” reading for the vendor industry.  It’s chock full of practical advice on how to “engineer” the PHM-physician partnership. While the focus of the article is on a practical approach to obesity, its approach can be applied to other conditions, such as diabetes or tobacco abuse.

Among the three key lessons that resonated with the physician Disease Management Care Blog:

1. Providers and PHM vendors should make liberal use of surveys outside of the provider-patient encounter.  The surveys should include a assessment of readiness to change and measures of baseline behaviors.  In the specific area of weight-loss, there is a short 5 item survey (go here, then Table 1 and then scroll to the 3rd of 4 lists) that assesses readiness that can then be paired with measures of diet and exercise knowledge and activity.  By the way, the paper has other references that describe other validated surveys that can used in weight management.

2.  The physician’s role is important because he or she can non-judgementally endorse, encourage and even “medicalize” the patients’ interest in lifestyle change  That being said however, “collaborative approaches that involve physicians, nurses, or other providers” can be first stop for the assessing the survey results and with tailored counseling and follow-up that practically matches the expertise of a physician.  In other words, the docs don’t need to do it.

3. The “internet” is emerging as an important option. It works best if it offers education, enables self monitoring, provides individualized goals, builds on motivation and has peer support.  It also helps if there is a “live” person somewhere in the loop.  There are some promising handheld device “apps” too.

While no one can argue that obesity is an important health issue and that primary care physicians have an important role to play, it’s difficult to address it in the usual course of a doctor-patient encounter.  The good news, however, is that if you call a busy doc up and point out that assessments can be done via survey, that there are effective counseling strategies that involve other health professionals and that the internet is a resource, they’ll endorse the approach.

Good news for the vendors, the docs and, most importantly, for the patients.

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