Screening for obesity: clinical tools in evolution, a WREN study.

BACKGROUND: The US Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. This recommendation acknowledges the absence of evidence for patient-oriented benefits (lower morbidity or mortality). OBJECTIVES: We sought to determine temporal trends in clinician attitudes toward screening for obesity using body mass index (BMI) and other modalities, before and after introduction of an American Academy of Family Physicians (AAFP) obesity screening toolkit. METHODS: We performed 3 cross-sectional attitudinal surveys (2005-2007) of Wisconsin family physicians before and after they received the Americans In Motion - AIM to Change Toolkit. RESULTS: Response rates were 19.5% of 1429 in the 2005 survey, 21.7% of 1797 in the April 2007 survey, and 14.3% of 1580 in the December 2007 survey. Virtually all clinicians (98% -99%) reported in all 3 surveys that they routinely measured adult weight. There was a significant increase in reporting the routine measurement of adult height (from 57% to 74%) necessary for calculation of BMI. While most clinicians (91% in 2004 and 96% in 2007) agreed that it is important to screen all patients for obesity, there was less agreement that screening was feasible or effective. CONCLUSIONS: While many Wisconsin family physicians endorse screening for obesity, fewer were convinced about screening's feasibility. We were unable to determine if the mailing of the AIM kit had a causal effect on the temporal trends observed.

Recruiting primary care clinicians for public health and bioterrorism surveillance.

CONTEXT: This study assessed differences in the effort and resources needed to recruit clinicians for a shortterm infectious disease sentinel surveillance project. OBJECTIVE: Measure differences in recruitment efficiency, time to obtain informed consent, and compliance to a Web-based demographic survey between 3 physician groups. DESIGN: We recruited Wisconsin clinicians by e-mail, phone, or fax from a primary care practice-based research network (PBRN), an influenza sentinel clinician program, and a state academy of family physicians to participate in a demographic survey prior to a surveillance project. RESULTS: Successful recruitment of a sentinel clinician required 2-3 hours of staff time. Clinicians affiliated with the PBRN had the highest recruitment efficiencies (1 recruit for every 1.67 contacts; P < 0.0001). Participants already involved in ongoing influenza surveillance returned consent forms faster than other clinicians (P = 0.044). We did not identify differences in questionnaire response time between the 3 groups (P = 0.718). CONCLUSIONS: We observed large and significant differences among 3 primary care groups in the efficiency of recruiting for participation in public health sentinel surveillance. Members of established networks were more approachable and rapidly recruited. Following recruitment, only minimal differences in performance were noted among the groups. Therefore, recruitment for sentinel surveillance is enhanced through the use of established clinic networks.

Computer interviewing in a primary care office: the patients are ready.

UNLABELLED: Computer patient interviewing has been used since 1968 and must be acceptable to a majority of patients for wide spread use to occur. Computer interviewing is still not used widely in the United States. Potential barriers have not been identified in the literature. METHODS: 150 of 164 (91.5%) eligible patients at a family medicine ambulatory practice were enrolled in a study to evaluate computer interview of cough and sore throat complaints. Subjects were given the choice to have the interview in the waiting or examination room. Telephone interviews were conducted 2-4 weeks later with 143/150 patients (95.3%). RESULTS: 102/150 (68%) of subjects chose the wait-ing room and 48/150 (32%) chose the examination room for the computer interview. 127/143 (88.8%) were willing to use the computer interview for evaluation of cough or sore throat again in the future. 116/143 (81.1%) were willing to use the computer interview for other medical complaints in the future. CONCLUSIONS: Patients are willing to use computer interview-ing and some interviews may be conducted in the waiting room.