By Julie L. White, MS, CHCP, Boston University School of Medicine; Krista Sierra, Haymarket Medical Education; and Angie Ladas, BS, Haymarket Medical Education
Improving outcomes for patients with obesity and reducing weight-related healthcare costs have been key focal points for a number of national organizations, as well as the U.S. Public Health Service. It is now understood that even a relatively small degree of weight loss can greatly decrease the risk for and impact of many of the complications of overweight and obesity.
In recent years, a number of novel therapeutic targets for obesity have been uncovered; subsequently, several new agents for weight loss have been developed. Because these agents can not only induce weight loss but also improve a number of cardiometabolic risk factors, use of pharmacotherapy in combination with lifestyle interventions for weight loss is now recommended by a number of medical authorities. For clinicians to utilize these agents optimally, they must be competent in explaining, recommending, monitoring and comparing pharmacologic efficacy, safety, tolerability and contraindications in terms that are easily understood by patients. In addition, a thorough recognition of individual characteristics that may contribute to obesity must be considered when selecting the most appropriate therapeutic approach.
With these tenets in mind, in 2014 Haymarket Medical Education (HME) and Boston University School of Medicine (BUSM) launched the Obesity Learning Center (OLC) on myCME.com for an audience of primary care clinicians. To date, over 10,000 healthcare practitioners have participated in OLC activities, which include education on risk stratification, lifestyle interventions, pharmacotherapy and patient education.
While participation in the modules that center on weight-loss medications has been especially robust, final outcomes assessments indicated that many clinicians still lacked confidence in their ability to treat obesity: Only 49 percent reported feeling competent to prescribe weight-loss agents, just 40 percent believed that their obese patients would lose a significant amount of weight no matter the intervention, and only 22 percent were confident that their patients could/would maintain weight loss over the long term.
To meet the persistent educational needs that were identified relative to obesity treatment in the primary care setting, we added several new CME activities to the OLC in 2016. Supported by Takeda and Novo Nordisk, these educational offerings were designed to more closely examine the individualization of weight-loss therapy, selection of therapy based on patient characteristics, and management of weight and related health risks over the long term. To determine and quantify performance changes that resulted from participation, we utilized pre-/post-activity surveys, program evaluations and follow-up surveys sent eight weeks after participation in each activity.
To date, 4,138 clinicians have received CME credit for participating in the new OLC activities. Analysis of outcome metrics shows significant improvements in knowledge, competence and practice relative to the treatment of obesity according to evidence-based guidelines and national benchmarks.
The three new OLC activities comprised an audio podcast to illustrate the application of evidence-based guidelines to practice; a videotaped roundtable discussion outlining current treatment paradigms for patients with obesity; and an additional videotaped roundtable focused on keeping patients with obesity engaged in care. In addition, the new content included software and web based patient engagement tools that clinicians could use in their daily practice to improve outcomes.
To extend the reach of this initiative to patients, we partnered with the Obesity Action Coalition (OAC). Through its patient outreach efforts, the OAC increased awareness of the initiative and provided other educational resources. To further engage patients and obtain patient-health data relative to the effectiveness of the intervention, we also partnered with Pack Health, an independent patient-engagement company that designed and manufactured high-quality, obesity-specific tool kits that clinicians who participated in the OLC activities could prescribe to their patients with obesity. In addition to resources like food diaries, activity trackers and pedometers, each toolkit included the contact information for the patient’s personal health adviser.
Key Findings and Data Analysis
Significant increases in knowledge and competence were documented for all three activities via pre- and post-activity surveys. Follow-up surveys conducted eight weeks after participation in each activity showed substantial practice changes relative to the learning objectives of the initiative. Notably, participants indicated that, after participating in one or more of the activities, they were more adherent to evidence-based guidelines for obesity management; focused obesity treatment on patients at greatest risk; utilized anti-obesity medication for appropriate patients; implemented strategies to better engage patients with obesity in treatment; and used motivational interviewing to educate patients with obesity.
Barriers to Practice Changes (All Activities)
When participants were asked to identify the barriers they encountered in trying to implement practice changes, the most common response — cited by 65 percent of learners overall — was patient adherence to therapy. Notably, while about 50 percent of MDs/DO, Pas and NPs indicated that patient adherence was a “sizable” barrier, only 27.3 percent of nurses said the same.
Currently, 100 patients of clinicians who participated in the OLC activities are enrolled in the Pack Health program. Early results indicate that the patient-engagement intervention has had a positive impact.
Key results at 12 weeks compared to baseline include:
- On average, participants lost 5.9 pounds.
- Average physical health (measured by PROMIS Global-10) increased by 10.2 percent.
- Average mental health (measured by PROMIS Global-10) increased by 10.3 percent.
- Participants’ sleep increased by 25 minutes per night on average.
The data collected via our outcomes analysis demonstrates that the educational activities were effective in improving the performance of primary care clinicians relative to the treatment of obesity within their practice. Collaborating with the OAC and Pack Health significantly extended the reach of the program to patients; uptake of the patient resource has been robust and initial data on patient health outcomes has been positive.
Barriers to practice changes remain and include lack of patient adherence, lack of time and insurance/reimbursement issues. To optimize obesity management in the primary care setting, educational interventions that target these barriers should be ongoing, as should efforts to educate and engage patients.