Frontline Experiences of a Practice Redesign to Improve Self-management of Obesity in Safety Net Clinics

Abstract

Background Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in three safety net clinics. Methods Key stakeholder interviews (n=21) were conducted both during early implementation of practice change and six months later; Patient surveys (n=393) examined obese patient activation and health status. Results Insufficient program resources and limited patient engagement due to external factors were implementation barriers, despite fairly high patient activation. Discussion Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Due to high turnover, multiple supporters may improve sustainability.

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

“…The most common term used was "teamlet" (n=16) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] . When initially proposed in 2007, it described a "dyad relationship" between a clinician and a health coach (health professionals whose expertise involve behaviour change and improving health outcomes by designing personalised goals and care plans for patients) 31 .…”

“…Huddles were described in seven papers 30,31,36,41,[43][44][45] . Although huddles do not have a standard definition, they are intended to be structured, brief (15 minutes), routine (multiple times a day), and face-to-face communication of a team's full membership 36,45 .…”

“…Staffing was reported as a key element in 11 studies 30,32,34,[36][37][38][39]41,44,46,47 . Flexibility in the team structure was described as an effective way to adapt to local resource constraints 41,[44][45][46]48,49 .…”

“…A cultural change of practice was described in 11 papers 30,[41][42][43][44][45][46][47][49][50][51] and included changes in values, perspectives and working processes. The identification of practice members who would act as a "champion of change" was mentioned in four studies 30,46,49,50 .…”

“…A cultural change of practice was described in 11 papers 30,[41][42][43][44][45][46][47][49][50][51] and included changes in values, perspectives and working processes. The identification of practice members who would act as a "champion of change" was mentioned in four studies 30,46,49,50 . These individuals would celebrate positive achievements and use practice data to demonstrate improved health outcomes for patients to motivate participating GPs and sustain the implementation of micro-teams in the long term.…”