Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: A qualitative study

Melanie Jay, Sumana Chintapalli, Allison Squires, Katrina F. Mateo, Scott E. Sherman, Adina L. Kalet

Research output: Contribution to journalArticle

Abstract

Background: Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting. Methods: We recruited 25 PACT teamlet members from a single VA study site - 11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist) - for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization. Results: Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients' weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA priorities through electronic health records and time allocation influenced teams to prioritize referral to MOVE! over weight management counseling. Conclusion: We found a diversity of attitudes, and practices within PACT, and identified factors that can enhance the MOVE! program and inform interventions to improve weight management within primary care. Although findings are site-specific, many are supported in the literature and applicable to other VA and non-VA sites with PCMH models of care.

Original languageEnglish (US)
Article number167
JournalBMC Family Practice
Volume16
Issue number1
DOIs
StatePublished - 2015

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Patient-Centered Care
Veterans
Primary Health Care
Patient Care Team
Weights and Measures
Counseling
Veterans Health
Obesity
United States Department of Veterans Affairs
Referral and Consultation
Communication
Interviews
Health Priorities
Nutritionists
Needs Assessment
Information Dissemination
Electronic Health Records
Primary Care Physicians
Home Care Services
Nurses

Keywords

  • Key informant interviews
  • Obesity
  • Primary care
  • Veterans
  • Weight management

ASJC Scopus subject areas

  • Family Practice

Cite this

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans : A qualitative study. / Jay, Melanie; Chintapalli, Sumana; Squires, Allison; Mateo, Katrina F.; Sherman, Scott E.; Kalet, Adina L.

In: BMC Family Practice, Vol. 16, No. 1, 167, 2015.

Research output: Contribution to journalArticle

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