Scientists at UC Davis have reviewed a successful telemedicine intervention to fight pediatric obesity, identifying which methods worked (or did not work) and how telemedicine programs can improve outcomes. The study was published in the Quality Management in Health Care journal.
The research team interviewed clinicians, staff and parents at clinics that enrolled in the Healthy Eating Active Living TeleHealth Community of Practice (HEALTH COP) program. Through the course of their investigation, they managed to identify four factors that assisted clinicians in addressing obesity with high success rates, including 1) strong clinic management support, 2) experienced physician champions, 3) parental involvement while designing programs and 4) cross-communication between clinics.
Ulfat Shaikh, who is a pediatrician and director of Healthcare Quality at the UC Davis School of Medicine and the first author of the study said: “We wanted to build capacity in clinics to help them prevent and manage childhood obesity. Now we understand how important it is to carefully select clinician champions, partner with parents on program design and make sure our counseling fits the cultural context.”
Obesity and excessive weight is a major problem in the United States since it affects 30 percent of children. It is a particular problem in rural areas where culture, poverty and low access to healthy foods exacerbate the tendency, Shaikh noted.
To address the problem, UC Davis created HEALTH COP, which is a virtual learning network that is capable of providing peer support and education to rural physicians. Clinicians were encouraged to keep records of each patient’s BMI and weight, discuss exercise and diet and propose simple lifestyle alterations. A previous study revealed that the program improved obesity assessments, children’s nutrition, counseling and activity.
In this assessment, researchers interviewed physicians, staff, nurses and parents at the 7 rural California clinics to determine how the program functioned.
Several obstacles were verified like the lack of resources and encouraging families to return for follow-up visits. Further, in busy clinics, clinicians were often found to be too busy to discuss obesity in their patients. Success depended on if clinic management fully supported the program.
“A critical factor was whether clinic leadership genuinely valued these efforts. Did they provide resources and visibly support the program? In this case, a top-down approach really made a big difference,” noted Shaikh.
Physician champions were crucial since they took extra time to learn the nutritional differences according to cultural contexts — for example, the difference between corn and white flour tortillas — while they encouraged people to make simple changes in diet.
“The parent comments were very poignant,” said Shaikh. “Though the program was directed at children, it influenced lifestyle changes in the whole family.”