Date Available

4-27-2018

Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Jessica Sass

Committee Member

Dr. Judi Daniels

Abstract

PURPOSE: The purpose of this study was to evaluate the effect of a provider education program on BMI screening practices and provider knowledge related to childhood obesity by implementing an educational intervention to advanced practice providers in a primary care clinic setting.

METHODS: A pretest/posttest design was used to examine changes in provider knowledge about BMI screening practices in children and adolescents, and lifestyle recommendations after a brief educational intervention was provided. A retrospective chart review was used to assess the screening and management practices for an elevated BMI percentile and provider documentation of lifestyle recommendations.

RESULTS: A total of 63 charts in the overweight and obese categories were reviewed for children ages 6-18 who presented for a well child visit from June 2017-March 2018. The sample consisted of 57% female, 63% Caucasian, 33% African American, and th-99th percentile. Of the 24 participants who met criteria for overweight (BMI between the 85th-94th percentile), none had a diagnosis of overweight, 79% had a discussion of lifestyle recommendations, and only 8% had specific counseling (including a specific discussion of weight status and potential next steps in treatment or referral at next visit) or labs that were being ordered or monitored. Of the 39 who met criteria for obesity, 41% had a diagnosis of either overweight or obese, 7.6% were referred for further treatment and management, 15% had specific counseling or labs ordered or monitored, and 87% had lifestyle recommendations documented.

Pre/post-survey results showed an increase in the knowledge-based questions about BMI screening and management after the education session; specifically, the age at which screening should begin, what is considered a healthy weight, and physical activity recommendations.

CONCLUSION: Childhood overweight and obesity is a complex problem that requires the collaboration of healthcare providers, schools, communities, and parents working to create a healthier generation. This study identified several areas the clinic can improve related to their BMI screening practices and management of pediatric patients who are overweight or obese. This study identified that patients have a BMI percentile calculated, but providers are not identifying and diagnosing these patients correctly. It was also identified that a very low percentage of patients are having labs monitored or being referred to the pediatric BMI clinic. Improving the BMI screening process, and provider compliance with diagnosing, referring patients to receive further treatment, and providing lifestyle counseling are important next steps to improve this process in the clinic.

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