Date Available

4-25-2019

Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Leslie Scott

Clinical Mentor

Jane Anne Smith

Committee Member

Dr. Dianna Inman

Abstract

Childhood obesity rates in the United States have tripled since the 1970s in the U.S. (CDC, 2018). Due to the persistent rise in obesity rate sin children and the possible health risks associated with obesity, it is important for pediatric providers to appropriately assess and treat childhood obesity. There is limited data on what pediatric providers in the primary care setting are doing to address this growing health problem. PURPOSE: The purpose of this study was to determine current assessment and intervention strategies for childhood obesity used by pediatric health care providers at the University of Kentucky, General Pediatric clinic. Current strategies and interventions used by pediatric primary care providers were evaluated and compared to current practice guidelines addressing screening, diagnosis, and co-morbidity assessment in overweight and obese pediatric patients. METHODS: A cross-sectional study design was used to examine how providers are following practice guidelines, in assessing, and treating childhood obesity. Pediatric primary care providers were invited to complete an on-line survey to determine current practice behaviors in assessing and treating childhood obesity within the general pediatric clinic. A retrospective electronic medical record review to evaluate the assessment and treatment of childhood overweight and obesity was also conducted. The electronic medical records of children ages 2 years and 17 years who presented to the Kentucky Clinic South for an annual well-child exam between February 2018 and August 2018 were reviewed. Chi-Square test of association was used to compare the assessment and treatment of overweight and obese children and determine if differences between type of primary care provider existed when assessing and treating the pediatric patient in primary care. Descriptive statistics were used to summarize results from the electronic medical record review and healthcare provider’s confidence and reported practice in assessing and treating childhood obesity RESULTS: The on-line provider survey was completed by 6 pediatric primary care providers. Most providers are confident in how they are assessing or treating childhood overweight and obesity in practice. Ninety-two percent reported appropriately following AAP guidelines in the management of childhood obesity. Barriers for treatment identified by the providers included lack of patient motivation, lack of parent involvement, and lack of clinic time. The electronic medical record review yielded 42 records that met inclusion criteria for enrollment into the study. Diet and exercise was included in the treatment plan 69% of the records. A follow-up appointment was included in the treatment plan 21% of the time and only 9.5% of the records showed co-morbidity laboratory screenings ordered or included in the treatment plan. CONCLUSION: Childhood obesity is a growing concern that may have significant implications on the adult health of Americans. Most pediatric health care providers were confident in how they are assessing and treating childhood obesity in practice. However, there were several disconnects between what providers are reporting and practice behaviors identified in the electronic medical records review. The results of this study may provide areas for needed improvement in the early recognition and treatment of childhood obesity by the primary care provider. The identification of provider-perceived barriers to treatment may also offer areas of needed clinical support to improve patient outcomes.

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