Screening and managing obesity: understanding paediatric residents' knowledge, attitudes and practice.

STUDY PURPOSE: Prior studies have identified paediatric attending physicians' screening and management patterns related to overweight/obesity, but less is known about resident physicians' behaviour. The objective was to understand paediatric resident physicians' knowledge, attitude and practice patterns of overweight/obesity screening and management. STUDY DESIGN: We performed a retrospective chart review of preventive visits conducted by residents between August and October 2019. Charts of patients 2-18 years with body mass index ≥85th percentile at the visit were reviewed (85th-<95th for age and sex defined as overweight, ≥95th defined as obese). A survey was distributed to residents assessing knowledge, attitudes and barriers towards obesity management. RESULTS: Of 1250 visits reviewed, 405 (32%) patients met the criteria for overweight or obesity. 39% were identified correctly by the provider, 53% were not identified and 8% were identified incorrectly. 89% of patients had diet history, 31% had physical activity and 43% had family history documented. Patients with obesity received physical activity documentation/counselling, portion size counselling, at least one referral, laboratory tests and a diagnosis more often than overweight patients. 84% of residents completed the survey. Although the majority of residents felt 'somewhat' or 'very' well prepared to counsel families about overweight/obesity, the majority thought their counselling on overweight/obesity was 'not at all' or 'slightly' effective. CONCLUSION: Despite residents feeling prepared and comfortable discussing overweight/obesity with patients, these diagnoses were often under-recognised or incorrectly made and appropriate counselling was lacking. Future work will focus on specific strategies to improve diagnosis, screening and management of overweight/obesity and include educational interventions and electronic medical record adaptations.

CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs.

OBJECTIVE: Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education. METHODS: Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's health care needs over time. We dichotomized confidence at "very confident" versus all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care. RESULTS: We collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs 39%, P < .05), including children with complex needs (17% vs 10%, P < .05). The odds of feeling "very confident" (AOR [95% CI]) was lower with increasing CSHCN score (0.61[0.51-0.72]) and was lower for resident versus attending encounters (0.39 [0.16-0.95]). Confidence was higher if the provider had previously seen that patient (2.07 [1.15-3.72]), and for well (2.50 [1.35-4.64]) or sick visits (3.18 [1.46-6.94]) (vs follow-up). Differences between residents and attending pediatricians regarding the relationship between confidence and visit characteristics for subsets of CSHCN are reported. CONCLUSION: All providers felt less confident caring for CSHCN; however, for certain needs, resident confidence did not increase with level of training. The data suggest potential educational/programmatic opportunities.

The Inner-City Asthma Intervention asthma counselor program: a collaborative model between physician and social worker to help empower families.

BACKGROUND: The Inner-City Asthma Intervention (ICAI) asthma counselor program was modeled after interventions proven to be effective by the National Cooperative Inner-City Asthma Study (NCICAS) with inner-city children with asthma. The objective of the ICAI program was to translate and implement the NCICAS intervention into the real-world setting. OBJECTIVE: To describe the unique pairing of a master's degree-level social worker asthma counselor (AC) and physician program manager (PM) as they collaborate to implement a successful chronic disease intervention program. METHODS: A case-study design was used to describe the asthma counselor program collaboration at our site. This information was supplemented by additional qualitative data from the final report submitted by the Alliance of Community Health Plans to the Centers for Disease Control and Prevention and from questionnaire data and enrollment and retention data compiled by Wood et al. RESULTS: A master's degree level trained social worker functioned as an AC and successfully collaborated with a physician PM to help combat one of the most common chronic diseases of childhood. This is evident when evaluating administration, recruitment, education and system issues, and community outreach. CONCLUSIONS: The AC/PM partnership is a blueprint of how a successful collaboration may be duplicated by future social worker-physician teams. An effective program needs to address administrative issues, patient recruitment, ongoing team education, patient retention, and community outreach. Practical examples of each element are described.