Service quality and attrition: an examination of a pediatric obesity program

Cote, Max P.; Byczkowski, Terri; Kotagal, Uma R.; Kirk, Shelley; Zeller, Meg H.; Daniels, Stephen R.

doi:10.1093/intqhc/mzh015

Cited by 95 publications

(136 citation statements)

References 38 publications

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“…Common barriers to follow-up for both clinics and programs included treatment schedules that were inconvenient because of school and work commitments and difficulties with transportation. These results are similar to those found by others 7,11,13 and can prompt programmatic changes such as after-hours clinic or program visits, open-enrollment group programs, and improving families' and providers' knowledge about alternative transportation options such as those that might be offered through insurance.…”

Section: Discussionsupporting

confidence: 87%

“…This difficulty is multilevel; there are patient-, provider-, institutional-, managed care-, and community-level barriers that affect the achievement of successful outcomes. One such barrier is the high rate of patient attrition from stage 3 weight-management clinics and programs [7][8][9] in both the initial treatment and maintenance phases of these programs. 10 Minimizing attrition is crucial for individual patient success.…”

mentioning

confidence: 99%

“…Common predictors of attrition include Medicaid status, black ethnicity, older age, depression, lower self-concept, 8 elevated parental BMI, race/ethnicity, 9 overall health status, overall quality of care, difficulty with medical insurance coverage, location and timing of program visits, unfulfilled parental expectations, and a child's desire to leave the program. 7,11 In the adult literature, women who had more previous weight-loss attempts were more likely to not complete a program. 12 It is possible that caregivers who have made multiple attempts at weight loss might negatively affect their child or adolescent's completion of a pediatric weight-management program.…”

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confidence: 99%

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Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations

et al. 2011

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Pediatric tertiary care institutions are well positioned to provide multidisciplinary, intensive interventions for pediatric obesity known as stage 3 treatment. One contributor to the difficulty in administering this treatment is the high rate of patient attrition. Little is known about the practices used by pediatric weight-management clinics and groupbased programs to minimize attrition. Hospital members and nonmembers of FOCUS on a Fitter Future were surveyed on the methods used to engage and retain obese children in their clinics and programs. Shortly thereafter, a benchmarking activity that centered on rates of patient nonattendance at initial and follow-up clinic visits was initiated among FOCUS-group-participating hospitals. Clinic-and group-based program results were contrasted. Staff from groupbased programs reported that the majority of patients did not complete even 50% of program follow-up visits. Multiple patient/family-and clinic/program-level barriers to retention were identified. Attention to successful techniques should be paid during planning for new programs and improvement of established ones. Pediatrics 2011;128:S59-S64

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

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confidence: 99%

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Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations

et al. 2011

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“…The level of attrition of our study was similar to other weight management interventions delivered in an outpatient setting (37) and highlights what happens under real-world conditions. While issues regarding attrition have been examined to a limited degree in the treatment of paediatric obesity (38)(39)(40), none have explored families' reasons for lack of engagement after being referred for multidisciplinary care. Given the high number of adolescents who failed to initiate care, gaining a better understanding of factors that explain why some families initiate care while others do not represents a knowledge gap.…”

Section: Discussionmentioning

confidence: 99%

One-on-one lifestyle coaching for managing adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting

Ball

Mackenzie-Rife

Newton

et al. 2011

Paediatrics &Amp; Child Health

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A pproximately two million Canadian boys and girls are overweight or obese (1,2), which places them at increased risk for several chronic diseases. Overweight and obese children referred for weight management often exhibit suboptimal lifestyle behaviours (3) -a finding that highlights the potential for interventions to promote healthier habits. These observations, along with recent clinical practice guidelines (4) and best practice recommendations (5), underscore the importance of healthy lifestyle behaviours as the cornerstone of paediatric weight management. Even in situations for which more intensive therapy may be indicated, nutrition, physical activity and behavioural counselling remain foundational strategies (6,7).Evidence supporting the successful treatment of paediatric obesity is primarily derived from group-based interventions, which tend to be more efficacious (8) and cost effective (9), and reduce attrition (10) versus one-on-one care. Alternately, one-on-one care is more feasible, appropriate (in some situations) and common in many Canadian paediatric weight management clinics (11). A key limitation of the aforementioned research is that most studies included community-based volunteers -a situation that differs for many paediatricians who refer obese boys and girls to multidisciplinary weight management clinics. Recently, the Canadian Institutes of Health Research (CIHR) emphasized the value of integrating research into practice-based settings as a way to enhance health services for Canadians (12). We believe that offering one-on-one interventions in clinics that provide paediatric weight management care and conduct applied research in real-world environments can inform health service delivery ) that does not include these techniques; and to determine whether the HIP and YLP interventions are superior to a wait list control (WLC) group. METHODS: Obese adolescents were randomly assigned to a YLP (n=15), HIP (n=17) or WLC (n=14) group. The YLP and HIP were 16-session, one-on-one interventions. The primary outcome was the percentage change of body mass index z-score. RESULTS: Completers-only analyses revealed 3.9% (YLP) and 6.5% (HIP) decreases in the percentage change of body mass index z-score compared with a 0.8% (WLC) increase (P<0.001). Levels of attrition did not differ among groups, but were relatively high (approximately 20% to 40%). CONCLUSION: Lifestyle interventions delivered in a real-world, clinical setting led to short-term improvements in the obesity status of adolescents.

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“…Other predictors of drop-out including black race, being of lower socioeconomic status [45], being an older adolescents, and expressing low perceived quality of care [46], may also have contributed to loss to follow-up among our patients, though consistent predictors of attrition have not been identified in weight clinics [4].…”

Section: Discussionmentioning

confidence: 88%

Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents

Sylvetsky¹,

Welsh²,

Walsh³

et al. 2012

OJPed

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Introduction: Pediatricians are encouraged to promote behavior modification to reduce childhood obesity and its co-morbidities, yet the effectiveness of office counseling is unclear. We aimed to evaluate if a low-intensity intervention (action-oriented counseling) in a clinic setting results in weight stabilization, and if the effect is modified by a diagnosis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that patients with NAFLD would be more motivated to adhere to the lifestyle goals set in clinic, due to the diagnosis of an obesity-related condition; and, would therefore achieve greater weight reduction compared to similarly overweight and obese patients without a diagnosis of NAFLD. Methods: A retrospective chart review was conducted on 73 (35 male, 38 female) overweight and obese patients (BMI ≥ 85th percentile) attending a pediatric GI clinic between January 2006 and October 2011. Analysis was conducted to determine if lifestyle goals discussed with the patient at each clinic visit were associated with improved BMI, BMI z-score, and liver enzymes. Treatment outcomes among NAFLD patients and similarly obese patients without NAFLD were compared using t-tests and chi-square tests. Results: Of the children evaluated, 74.0% achieved a reduction or stabilization in BMI z-score after 3 months of follow-up. Among NAFLD patients, liver enzymes improved in 72% of those who were able to stabilize or reduce their BMI and among 43% of those who gained weight. Treatment outcome did not significantly differ based on having a diagnosis of NAFLD, although there was a trend towards greater improvements. Conclusion: Our study suggests that action oriented counseling including goalsetting in a low intensity, clinic based approach is effective in improving patient BMI, in the presence or absence of an obesity-related co-morbidity, such as NAFLD. Further, we demonstrated that lifestyle modification led to improvement of liver enzymes in NAFLD patients and may result in other clinically relevant improvements. Longer studies will be needed to determine if the improvements are sustained.

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Service quality and attrition: an examination of a pediatric obesity program

Cited by 95 publications

References 38 publications

Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations

Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations

One-on-one lifestyle coaching for managing adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting

Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents

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