Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting.

Abstract

In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity.

• Authors: A Fleischman, S E Hourigan, H N Lyon, M G Landry, J Reynolds, S K Steltz, L Robinson, S Keating, H A Feldman, R C Antonelli, D S Ludwig, C B Ebbeling
• Journal: Clinical obesity (Clin Obes) Vol. 6 Issue 6 Pg. 380-388 (Dec 2016) ISSN: 1758-8111 [Electronic] England
• PMID: 27863024 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2016 World Obesity Federation.

Topics

• Adolescent
• Body Mass Index
• Child
• Community Health Services (organization & administration)
• Female
• Humans
• Interdisciplinary Communication
• Male
• Pediatric Obesity (therapy)
• Pilot Projects
• Primary Health Care (organization & administration)
• Referral and Consultation
• Telemedicine (organization & administration)