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Child obesity intervention

Child obesity intervention with IT support effective

BMI increased less among children receiving the intervention that used CDS tools without health coaching

An intervention programme utilising computerised health records could lead to improvements in children’s BMI, according to a paper ‘Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care - A Cluster-Randomized Clinical Trial’ published in JAMA Pediatrics. The study, which was conducted to find out to what extent computerised clinical decision support (CDS) for paediatric clinicians helped to improve the BMI and quality of care of obese children, report that an interventions that included computerised CDS for paediatric clinicians and support for self-guided behaviour change for families resulted in improved childhood BMI. Both interventions improved the quality of care for childhood obesity.

"Despite the availability of obesity management guidelines, interventions to improve BMI in children have not proved effective in the context of primary care, and paediatric clinicians have been slow to adopt recommended screening and management practices," write the authors.

They suggest that reliable clinical information systems could help to improve obesity management. "The use of electronic health records offers the potential for improving the quality of care for obese children and for accelerating the use of evidence on obesity screening and management by primary care clinicians," the authors state.

Dr Elsie Taveras of Massachusetts General Hospital for Children, Boston, and colleagues set out to trial child obesity interventions in a randomised three-arm clinical trial. A total of 549 obese children aged 6-12 from 14 primary care practices were enrolled and tracked from October 2011 to June 2012. For one arm of the trial, five practices (194 children) had access to modified electronic health records that alerted paediatric clinicians to children with high BMIs and provided links to obesity screening guidelines, growth charts and information on weight management programmes.

Paediatric clinicians also provided additional educational materials and emphasized the importance of behavioural changes during follow-up visits, such as reducing consumption of sugar-sweetened beverages and getting more exercise.

For the second arm of the trial, another five practices (171 children) gave this level of support but also assigned a health coach to work with the families of obese children by telephone, text message and email.

Finally, the remaining four practices (184 children) gave standard levels of care, with no additional CDS tools for treating obesity.

The researchers found that the children whose families and paediatricians adhered most faithfully to the intervention utilising both CDS tools and health coaching experienced the greatest reductions in BMI, in comparison with the participants that received standard care. Participants that were not completely faithful to the interventions did not experience improvements to their BMI.

At baseline, mean (SD) patient age and BMI were 9.8 (1.9) years and 25.8 (4.3), respectively. At one year, they obtained BMI from 518 children (94.4%) and HEDIS measures from 491 visits (89.4%). The three randomisation arms had different effects on BMI over time (p=0.04). Compared with the usual care arm, BMI increased less in children in the CDS arm during one year (−0.51 [95% CI, −0.91 to −0.11]). The CDS + coaching arm had a smaller magnitude of effect (−0.34 [95% CI, −0.75 to 0.07]). They also reported a substantially greater achievement of childhood obesity HEDIS measures in the CDS arm (adjusted odds ratio, 2.28 [95% CI, 1.15-4.53]) and CDS + coaching arm (adjusted odds ratio, 2.60 [95% CI, 1.25-5.41]) and higher use of HEDIS codes for nutrition or physical activity counselling (CDS arm, 45%; CDS + coaching arm, 25%; p<0 .001 compared with usual care arm).

Although the intervention that included individual coaching resulted in the greatest reductions in BMI among the most faithful participants, the researchers found that overall, BMI increased less among children receiving the intervention that used CDS tools without health coaching.

"The number of coaching sessions or their frequency or content might have been insufficient to produce greater effects than the CDS and self-guided intervention," the authors suggest. "Future studies should determine what minimal amount of coaching is necessary to achieve improvement in childhood obesity interventions."

The authors acknowledge that the study may be limited by the fact that the biggest improvements to BMI among the children in the highest-fidelity group could potentially be due to differences in motivation for this group rather than due to the intervention being more effective.

"We found that an intervention that leveraged efficient health information technology to provide CDS for paediatric clinicians and that provided an intervention for self-guided behaviour change by families resulted in improvements in the children's BMI," the authors conclude.

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