PDF(Pubmed)
Abstract：
Context: Despite the fact that obesity is both treatable and preventable, treating the comorbidities, rather than obesity per se remains the mainstay of therapy. Objective: To evaluate the efficacy and implementation of a pragmatic approach to weight management in primary care that prioritizes treatment of weight rather than weight-related diseases (PATHWEIGH). Study Design and Analysis: PATHWEIGH is a hybrid type 1 cluster randomized stepped wedge clinical trial. Clinics were enrolled and randomized to three sequences using covariate constrained randomization. Descriptive statistics were used to summarize clinic and patient characteristics with t-tests, Wilcoxon rank sums or Fisher\'s exact tests used to compare groups. Setting: Fifty-seven primary care clinics in rural, suburban and urban Colorado in a single healthcare system were utilized. Population Studied: Patients age >18 years and body mass index (BMI) >25 kg/m2 who had a weight-prioritized visit (WPV) in the prior year were enrolled. A WPV was defined as a chief complaint or reason for visit that included \"weight\", ICD-10 codes for weight or use of an intake questionnaire for weight. Intervention: None. This abstract describes the baseline (pre-intervention) characteristics of the clinics and patients treated with standard-of-care (SOC) for weight management. Outcome Measures: Baseline characteristics of the clinics and patients undergoing a WPV from March 17, 2020 - March 16, 2021. Results: 20,410 patients met these eligibility requirements representing 12% of patients >18 years and body mass index (BMI) >25 kg/m2 seen at the clinic during this baseline period. The three randomization sequences of 20, 18, and 19 sites were similar with an overall median age of 53 years (IQR: 39-65), 58% women, 76% non-Hispanic whites, 64% commercial insurance, and median BMI of 36 kg/m2 (IQR: 32-41). No sequence differences were seen for vital signs, relevant laboratory values, or numbers of comorbidities or medications that cause weight loss or weight gain. Referral for anything weight-related was low (<6%) and only 334 prescriptions of an anti-obesity medication were noted. Conclusions: Of patients >18 years and body mass index (BMI) >25 kg/m2 seen in the 57 primary care clinics, 12% had a weight-prioritized visit during the baseline period. Despite most being commercially insured, referral to any weight-related service or prescription of anti-obesity medication was uncommon.
摘要：
背景：尽管肥胖是可以治疗和预防的，治疗合并症，而不是肥胖本身仍然是治疗的主要支柱。目的：评估初级保健中体重管理的务实方法的有效性和实施情况，该方法优先治疗体重而不是体重相关疾病（PATHWEIGH）。研究设计和分析：PATHWEIGH是一个混合1型整群随机阶梯式楔形临床试验。使用协变量约束随机化将诊所登记并随机分为三个序列。描述性统计用于通过t检验总结临床和患者特征，用于比较组的Wilcoxon等级和或Fisher精确检验。地点：农村57个初级保健诊所，郊区和城市科罗拉多州在一个单一的医疗保健系统被利用。研究人群：招募年龄>18岁，体重指数（BMI）>25kg/m2的患者，在前一年进行了体重优先就诊（WPV）。WPV被定义为主要投诉或访问原因，包括“体重”，ICD-10编码体重或使用体重摄入问卷。干预：无。本摘要描述了诊所和接受标准护理（SOC）体重管理的患者的基线（干预前）特征。结果指标：2020年3月17日至2021年3月16日接受WPV的诊所和患者的基线特征。结果：20,410例患者符合这些资格要求，代表12％的患者>18岁，体重指数（BMI）>25kg/m2在该基线期间在诊所看到。20、18和19个地点的三个随机序列相似，总体中位年龄为53岁（IQR：39-65），58%的女性，76%的非西班牙裔白人,64%的商业保险,BMI中位数为36kg/m2（IQR：32-41）。没有发现生命体征的序列差异，相关实验室值，或导致体重减轻或体重增加的合并症或药物的数量。任何与体重相关的转诊都很低（<6％），仅注意到334种抗肥胖药物的处方。结论：在57个初级保健诊所中看到的患者>18岁且体重指数（BMI）>25kg/m2，12%的人在基线期间进行了体重优先访问。尽管大多数人都有商业保险，转诊任何与体重相关的服务或抗肥胖药物的处方并不常见.
