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Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial
Author(s) -
Iwamoto Sean,
Saxon David,
Tsai Adam,
Leister Erin,
Speer Rebecca,
Heyn Hilde,
Kealey Elizabeth,
JuarezColunga Elizabeth,
Gudzune Kimberly,
Bleich Sara,
Clark Jeanne,
Bessesen Daniel
Publication year - 2018
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1002/oby.22223
Subject(s) - medicine , primary care , obesity , weight loss , weight management , psychological intervention , physical therapy , family medicine , nursing
Objective To examine the impact of a 1‐year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. Methods PCPs from four intervention clinics (PCP‐I) and five control clinics (PCP‐C) completed pre‐ and postintervention surveys on weight‐loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP‐I received patient updates and education about obesity management. Results Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP‐C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP‐C: 8.37 [1.24]; P = 0.8; pre/post PCP‐I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP‐I (pre/post PCP‐C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP‐I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP‐I (pre/post PCP‐C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP‐I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP‐C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP‐I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP‐C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP‐I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP‐I. Conclusions PCPs initially overvalued exercise and undervalued weight‐loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight‐loss medications.