Ten years ago, electronic health records were making the news. Professionals were excited about the opportunity to intervene more “aggressively,” though that might not have been the most thoughtful or helpful choice of words. Programmed alerts of various kinds were welcomed by practitioners and patients alike. But in the realm of pediatric obesity, researchers could not help noticing that computers were not really doing a good job keeping track of whether the electronic systems actually helped children to reduce their weight, or at least slow down their rates of gaining pounds.
Also, it was noted that some families were not ready or able to adjust their lifestyles in order to adapt to electronic systems. At the same time, some doctors also found it difficult to change their ways. An uncredited writer reported,
To prepare physicians for these new EHR tools, the researchers provided a one-hour training class…. individual training, as opposed to group classes, could improve performance. “The alerts led to significant but not dramatic improvements,” said Ulfat Shaikh, lead researcher, pediatrician and director of Healthcare Quality at the UC Davis School of Medicine. “We believe any electronic record intervention must be combined with other approaches.”
That, in itself, should not come as a surprise. Grownups are like children in many ways, and for both groups, some learning is absorbed better if the contact is individual and personalized. This is why, for instance, pharmaceutical corporations customarily sent attractive sales reps from office to office to tell doctors one-on-one about the benefits of their products.
To measure whether EHRs enhance practice, the researchers added obesity-related alerts to health records at the UC Davis Health System’s outpatient clinic, which cares for about 12,000 children each year. The alert — highlighted in bright yellow on the screen — warned physicians when a patient’s weight hit the 85th percentile, which is considered “overweight.”
The doctor would then be electronically guided through a series of steps that had been found helpful in addressing weight issues. Patients and their families were to be educated about “diet, exercise, screen time and other behaviors associated with obesity.” These discussions were to be documented. Appropriate lab tests would be recommended, in addition to referrals to dietitians, and follow-up contacts would be scheduled.
As a result, the proportion of children with diagnoses of overweight or obesity increased from 40% to 57%. More kids were sent for lab tests for diabetes and abnormal blood levels of cholesterol and fat. Recommendations for follow-up appointments almost doubled. And yet, for some reason, referrals to dietitians did not increase. Was this necessarily a bad thing? Because, as Dr. Pretlow says, pretty much everybody already knows about calories and nutritional guidelines, and if they had not started following helpful eating practices yet, this might not be enough of a nudge to make them change their ways. It became apparent that referrals were needed not to dietitians, but to counselors, social workers, and cognitive behavioral therapists.
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Source: “UC Davis Study Offers New Insights Into Controlling Pediatric Obesity,” Benzinga.com, 01/29/14
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