RESUMO
BACKGROUND: The national and international epidemic of chronic disease, including among children, is largely fueled by increasing obesity. It is recommended that primary care play a key role in the treatment of pediatric obesity. METHODS: A written survey was administered to providers and staff at 13 primary care practices across North Carolina, assessing perceptions on multiple dimensions of pediatric obesity treatment and knowledge of dietitian services. RESULTS: The response rate for the survey was 66.9% (n = 273). Although providers reported feeling comfortable and confident in many areas of childhood obesity, perceived effectiveness was low. Moreover, comfort and confidence were lower for non-primary care providers (PCPs) involved in obesity treatment than for PCPs, and PCP comfort and confidence levels were low for the ability to conduct motivational interviewing and for knowledge of billing for obesity as a diagnosis. Personnel perceived that there were benefits to having a registered dietitian (RD) in their practice and generally understood RD capacity. Survey results provided no evidence that integration of an RD into the practice changed perceptions or knowledge over the course of 1 year. LIMITATIONS: The present study included only 13 practices, mostly rural and all of at least moderate size. CONCLUSION: Significant change is required if primary care practices are to play the role envisioned for them in stemming childhood obesity and chronic disease. Change will require identifying and addressing specific knowledge and skill gaps, such as those identified in this study. Respondents' positive perceptions of the benefits of RD integration suggest the importance of exploring this clinical model.
Assuntos
Serviços de Dietética/tendências , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/terapia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/tendências , Criança , Doença Crônica/prevenção & controle , Diabetes Mellitus/etiologia , Serviços de Dietética/normas , Pesquisas sobre Atenção à Saúde , Humanos , Hipertensão/etiologia , North Carolina , Obesidade/complicações , Padrões de Prática Médica/normas , Atenção Primária à Saúde/métodosAssuntos
Programas Governamentais/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , North Carolina/epidemiologia , Prevalência , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
AIM: The article reports on the recommendations from the Diabetes Primary Prevention Project that was initiated and funded by the Division of Diabetes Translation, Centers for Disease Control and Prevention, and developed by the National Association of Chronic Disease Directors. METHOD: Essential components of statewide programs are delineated for effective interventions for diabetes primary prevention. The recommendations were derived from a structured process that is detailed on the basis of a cross-comparison of state-level diabetes prevention initiatives in six states where such programs were most developed. RESULTS: The recommendations focus on state-level partnerships, statewide program planning, required resources, policies, benchmarks for progress, and data collection. CONCLUSION: Illustrations are provided regarding how the project influenced the six participating states in further developing their programs for the primary prevention of diabetes.