Solving the Puzzle: Utilizing Research and Experience to Better Understand and Address Patient Retention Courtney Bascom, UVA Dietetic Intern Amanda Crane, RDN Outpatient Pediatric Registered Dietitian Nutritionist University of Virginia Children s Hospital
Outline Background Prevalence of pediatric obesity Co-morbidities & associated chronic diseases Multi-disciplinary pediatric weight management clinics Pediatric weight management clinics in Virginia Children s Fitness Clinic at UVA Health System Research on challenges Challenges to retention Practical approaches
Prevalence Children ages 2-19 in the US 1 17% have a BMI at or above the 95 th percentile 32% have a BMI at or above the 85 th percentile 17% of children & adolescents ages 2-19 were obese between 2011-2014 2 2-5 year olds: 8.9% 6-11 year olds: 17.5% 12-19 year olds: 20.5% In 2014 childhood obesity in Virginia reached 28.5% 3 20 th in the country
2
Demographics Higher rates of obesity and overweight 4 Race Parents degree of education 2
Co-morbidities & Associated Chronic Diseases Type II Diabetes Hypertension Dyslipidemia Steatohepatitis Sleep apnea Gallstones Orthopedic problems 5-7 https://www.nationalbariatriclink.org/bariatric-blog/obesity/
Multi-Disciplinary Pediatric Weight Management Clinics Comprehensive team 6 Identify specific dietary and lifestyle behaviors 13 Addresses the multi-factorial etiology of pediatric overweight and obesity 11-12 Duration and frequency of visits 14 Individualized interventions
Pediatric Weight Management Clinics in Virginia The Children s Fitness Clinic at The University of Virginia Health System The Obesity Institute IDEAL Clinic at Children s National Health System Healthy Lifestyle Clinic at Children s Hospital of Richmond at VCU 8-10 Children s Hospital of the King s Daughters Healthy You for Life Program
Children s Fitness Clinic at UVA Health System Gender Mean age Mean BMI Number of visits Race
Research on Challenges Scheduling 15 Lack of awareness of severity of health condition 16 Distance from clinic 16-17 Age 6 Mismatched expectations between clinic and patient/family 6,15
A Clinician s Perspective Retention rate at the CFC Reasons for attrition Life stressors Holidays/vacation Change in insurance/job Scheduling Unpleasant experience Busy schedules School Parents work schedules Cost of gas/transportation Lacking variety
Brainstorming Activity What are some specific ways to increase retention in the following scenarios? As a clinician Your facility Your community
Conclusion Childhood obesity continues to be a complex issue experienced on both the national and state level Dietary and lifestyle interventions are necessary for preventing negative health outcomes for children as they grow into adults A multi-disciplinary approach offers the most comprehensive care for preventing these potential health conditions Maximizing patient retention and overcoming barriers is essential to a successful weight management program
Questions? Amanda Crane, RDN E-mail: ac6jb@virginia.edu Courtney Bascom, Dietetic Intern E-mail: cb2ut@virginia.edu
References 1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012;307(5):483-490. doi: 10.1001/jama.2012.40 [doi]. 2. Ogden, C., Carroll, M., Fryar, C., & Flegal, K. (2015, October 28). Prevalence of Obesity Among Adults and Youth: United States, 2011 2014. Retrieved March 14, 2017, from https://www.cdc.gov/nchs/products/databriefs/db219.htm 3. Virginia performs: Obesity. http://vaperforms.virginia.gov/indicators/healthfamily/obesity.php. Updated 2016. Accessed November 30, 2016. 4. Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the united states, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292-2299. doi: 10.1001/jama.2016.6361 [doi].
References 5. Skelton JA, Goff DC,Jr, Ip E, Beech BM. Attrition in a multidisciplinary pediatric weight management clinic. Child Obes. 2011;7(3):185-193. doi: 10.1089/chi.2011.0010 [doi]. 6. Skelton JA, Beech BM. Attrition in paediatric weight management: A review of the literature and new directions. Obes Rev. 2011;12(5):e273-81. doi: 10.1111/j.1467-789X.2010.00803.x [doi]. 7. Dietz WH. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics. 1998;101(3 Pt 2):518-525. 8. Children's fitness clinic. https://med.virginia.edu/pediatrics/about/clinical-and-patientservices/668-2/. Updated 2016. Accessed December 4, 2016. 9. Healthy lifestyle center. http://www.chrichmond.org/services/healthy-lifestyles-center.htm. Updated 2016. Accessed December 4, 2016. 10.Obesity institue IDEAL clinic. http://childrensnational.org/departments/obesity-clinic. Updated 2016. Accessed December 4, 2016.
References 11.Savoye M, Berry D, Dziura J, et al. Anthropometric and psychosocial changes in obese adolescents enrolled in a weight management program. J Am Diet Assoc. 2005;105(3):364-370. doi: S0002822304018516 [pii]. 12.Whitlock EP, O'Conner EA, Williams SB, Beil TL, Lutz KW. Effectiveness of primary care interventions for weight management in children and adolescents: An updated, targeted systematic review for the USPSTF.. 2010. doi: NBK36416 [bookaccession]. 13.Eneli IU, Cunningham A, Woolford SJ. The pediatric multidisciplinary obesity program: An update. Prog Pediatr Cardiol. 2008;25(2):129-136. doi: http://dx.doi.org/10.1016/j.ppedcard.2008.05.011. 14.Geer B, Porter RM, Haemer M, Krajicek MJ. Increasing patient attendance in a pediatric obesity clinic: A quality improvement project. J Pediatr Nurs. 2014;29(6):528-535. doi: 10.1016/j.pedn.2014.09.001 [doi].
References 15.Hampl S, Demeule M, Eneli I, et al. Parent perspectives on attrition from tertiary care pediatric weight management programs. Clin Pediatr (Phila). 2013;52(6):513-519. doi: 10.1177/0009922813482515 [doi]. 16.Jelalian E, Hart CN, Mehlenbeck RS, et al. Predictors of attrition and weight loss in an adolescent weight control program. Obesity (Silver Spring). 2008;16(6):1318-1323. doi: 10.1038/oby.2008.51 [doi]. 17.Barlow SE, Ohlemeyer CL. Parent reasons for nonreturn to a pediatric weight management program. Clin Pediatr (Phila). 2006;45(4):355-360.