Success Story - Primary Care Provider Survey
October 2004
Contact Person
Kristine Perry/Barbe West
Funded Community
Community Choices
Description
Clark County STEPS staff and Health Systems Intervention Team developed and had a UW intern administer a survey to the five major primary care provider groups and their respective quality improvement staff on the use of the Body Mass Index. The purpose of the clinical practice guidelines interview was to assess the range of clinical practice variations for the three chronic conditions of overweight/obesity, asthma, and diabetes, as well as for underlying behavioral risk factors such as diet, physical activity, and tobacco use in health care systems. This preliminary assessment of clinical practices in Clark County will direct further activity aimed at promoting best practices toward STEPS objectives.
While not all respondents had clinical practice guidelines, there was consensus in making use of information recommended by specialist societies (American Diabetic Association, American Lung Association, American Heart Association, etc.), the U.S. Preventive Services Task Force, and insurance and pharmaceutical companies as general resources for both patients and clinicians.
Four out of five Primary Care Provider (PCP) groups had BMI practice guidelines for specific targeted diagnostic groups. Weight management was the most common justification for use of BMI clinical guidelines. Clinical guidelines that incorporated the use of the BMI as a screening tool were available for patients with a BMI greater than 27, a diagnosis of obesity, cardiac disease, or type II diabetes. Some clinicians now use practice guidelines that are downloaded and stored in their palm pilots. One group utilized BMI guidelines only for patients needing bariatric surgery.
Obesity/Weight Management
- Three PCP groups had clinical guidelines for weight management that addressed obesity.
Type II Diabetes
- 100% of the PCP groups reported having clinical guidelines for type II diabetes.
- Three out of five identified using the American Diabetic Association Guidelines. Other identified sources for diabetic guidelines were the U.S. Preventive Services Task Force (USPSTF) and insurance-care guidelines such as Pacificare.
Asthma Clinical
- Three out of five PCP groups had clinical guidelines for asthma.
Tobacco Use:
- Four out of five PCP groups had clinical guidelines regarding tobacco use.
- The group without clinical guidelines stated that they do record client tobacco use in the patient’s medical record.
Nutrition and Physical Activity:
- One group indicated that they had clinical guidelines for nutrition and physical activity for diabetic patients.
- One group had investigated USPSTF guidelines but was not sure how to implement these guidelines.
- Another group shared that they hoped to add nutrition and physical activity as risk factors to their intake form, drawing from examples at the Diabetes Collaborative.
All groups either provided or referred patients to weight management, nutrition and diet counseling, exercise fitness specialists, mental health counseling, or tobacco cessation programs as needed.
Concern was expressed over the lack of reimbursement for weight management. Provider groups would like to record BMIs, and encourage healthier lifestyles with increased physical activity and better nutrition; but unless the patient is diabetic or has a diagnosis of obesity, reimbursement for these services is not provided. Consequently, a BMI often gets coded as “weight management.” Further, apprehension still exists among providers about discussing weight status, as well as smoking status and drinking status.
A thousand dollar stipend was given to the UW intern for her time and effort on administering and compiling information and data for this survey.
As far as lessons learned the STEPS Clark County Health Systems Intervention Team found the survey very helpful in determining next steps in working with Health System organizations to improve standardization of prevention messages and clinical practices around obesity, diabetes and asthma.
