Identifying barriers and facilitators to improving the implementation of weight management services within a patient-centered medical home

Melanie Jay, Sumana Chintapalli, Katherine Oi, M Home, Allison Squires, Adina L. Kalet, Scott E. Sherman

Research output: Contribution to journalMeeting Abstract

Abstract

BACKGROUND: The Veterans Affairs (VA) Healthcare System uses Patient-Aligned Care Teams (PACT) as part of its patient-centered medical home model. "Teamlets" often consist of an RN, an LPN, a program assistant, and a PCP who are tasked with screening for obesity, providing brief interventions, counseling patients, and advising eligible patients to attend MOVE!, an intensive weight management program. While every VA hospital has a MOVE! Program to address the high prevalence of overweight and obesity among Veterans, less than 10 % of eligible patients attend even one session. Since Veterans visit PACT 3.6 times per year, there are opportunities to improve counseling and service coordination. A single-center, qualitative research study of healthcare team members assessed attitudes and practices as well as elicited barriers and facilitators to care implementation for overweight and obese patients. METHODS: We recruited healthcare team members for individual key informant interviews using a combination of convenience and snowball sampling. We used a semi-structured interview guide with questions informed by the Theory of Planned Behavior. Interviews lasted 30-60 min and were conducted by a general internist in a private office while a research assistant took field notes. The interviews were audio recorded and transcribed by a transcription company. Research assistants reviewed transcripts to correct mistakes and de-identify content. Analysts then used an iterative and directed coding approach, facilitated by NVivo software and structured by an initial coding guide developed from field notes and recollections. The primary coder segmented and coded each transcript, allowing additional codes to emerge. A second researcher then independently coded each segment. The researchers met frequently to harmonize codes and synthesize themes that emerged from coded transcripts. RESULTS: There were 25 participants in the study (11MDor NP, 5 RN, 2 RD, 5 LPN, 2 Other, with 6 holding an additional managerial role); 80%were female, 48%identified as White, 28 % African American, 16 % Asian, and 8 % Hispanic. Emerging themes included: system constraints, patient barriers, and perceived role responsibility.We found that performance measures and reminders motivate and shape current practices by the PACT teamlets. Barriers to treating patients included time, competing demands, and lack of understanding about what happens in the MOVE! Program. Facilitators included having received training in motivational interviewing (MI) and having a personal interest in nutrition and physical activity. Perceptions about role responsibility varied, with some RNs, LPNs, and MDs perceiving that they play important roles in weight management counseling, while others stated that it was the role of other team members. Similarly, perceived counseling competency varied within and between the different professions. For instance, some RNs and PCPs described in great detail how they used MI to counsel patients around weight, while others questioned whether they had adequate time and training. CONCLUSIONS: These data allowed us to identify several approaches to improve weight management by the PACT teamlets and will inform the design of PACT-based weight management interventions. Findings, however, may be organization-specific, so replication of the study at other sites is necessary to determine common implementation issues.
Original languageEnglish (US)
Pages (from-to)S115
JournalJournal of General Internal Medicine
StatePublished - 2014

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Patient-Centered Care
Patient Care Team
Weights and Measures
Counseling
Veterans
Interviews
Motivational Interviewing
Obesity
Research Personnel
Veterans Hospitals
Qualitative Research
Hispanic Americans
Research
African Americans
Software
Organizations
Exercise
Delivery of Health Care

Keywords

  • *human
  • *internal medicine
  • *patient
  • *society
  • *weight
  • African American
  • Asian
  • Hispanic
  • Theory of Planned Behavior
  • computer program
  • counseling
  • error
  • female
  • health care
  • health care system
  • hospital
  • implantable cardioverter defibrillator
  • internist
  • interview
  • model
  • motivational interviewing
  • nutrition
  • obesity
  • occupation
  • physical activity
  • prevalence
  • qualitative research
  • responsibility
  • sampling
  • scientist
  • screening
  • semi structured interview
  • veteran

Cite this

Identifying barriers and facilitators to improving the implementation of weight management services within a patient-centered medical home. / Jay, Melanie; Chintapalli, Sumana; Oi, Katherine; Home, M; Squires, Allison; Kalet, Adina L.; Sherman, Scott E.

In: Journal of General Internal Medicine, 2014, p. S115.

Research output: Contribution to journalMeeting Abstract

@article{70314d00e1d64285aa8993bdc934c23f,
title = "Identifying barriers and facilitators to improving the implementation of weight management services within a patient-centered medical home",
abstract = "BACKGROUND: The Veterans Affairs (VA) Healthcare System uses Patient-Aligned Care Teams (PACT) as part of its patient-centered medical home model. {"}Teamlets{"} often consist of an RN, an LPN, a program assistant, and a PCP who are tasked with screening for obesity, providing brief interventions, counseling patients, and advising eligible patients to attend MOVE!, an intensive weight management program. While every VA hospital has a MOVE! Program to address the high prevalence of overweight and obesity among Veterans, less than 10 {\%} of eligible patients attend even one session. Since Veterans visit PACT 3.6 times per year, there are opportunities to improve counseling and service coordination. A single-center, qualitative research study of healthcare team members assessed attitudes and practices as well as elicited barriers and facilitators to care implementation for overweight and obese patients. METHODS: We recruited healthcare team members for individual key informant interviews using a combination of convenience and snowball sampling. We used a semi-structured interview guide with questions informed by the Theory of Planned Behavior. Interviews lasted 30-60 min and were conducted by a general internist in a private office while a research assistant took field notes. The interviews were audio recorded and transcribed by a transcription company. Research assistants reviewed transcripts to correct mistakes and de-identify content. Analysts then used an iterative and directed coding approach, facilitated by NVivo software and structured by an initial coding guide developed from field notes and recollections. The primary coder segmented and coded each transcript, allowing additional codes to emerge. A second researcher then independently coded each segment. The researchers met frequently to harmonize codes and synthesize themes that emerged from coded transcripts. RESULTS: There were 25 participants in the study (11MDor NP, 5 RN, 2 RD, 5 LPN, 2 Other, with 6 holding an additional managerial role); 80{\%}were female, 48{\%}identified as White, 28 {\%} African American, 16 {\%} Asian, and 8 {\%} Hispanic. Emerging themes included: system constraints, patient barriers, and perceived role responsibility.We found that performance measures and reminders motivate and shape current practices by the PACT teamlets. Barriers to treating patients included time, competing demands, and lack of understanding about what happens in the MOVE! Program. Facilitators included having received training in motivational interviewing (MI) and having a personal interest in nutrition and physical activity. Perceptions about role responsibility varied, with some RNs, LPNs, and MDs perceiving that they play important roles in weight management counseling, while others stated that it was the role of other team members. Similarly, perceived counseling competency varied within and between the different professions. For instance, some RNs and PCPs described in great detail how they used MI to counsel patients around weight, while others questioned whether they had adequate time and training. CONCLUSIONS: These data allowed us to identify several approaches to improve weight management by the PACT teamlets and will inform the design of PACT-based weight management interventions. Findings, however, may be organization-specific, so replication of the study at other sites is necessary to determine common implementation issues.",
keywords = "*human, *internal medicine, *patient, *society, *weight, African American, Asian, Hispanic, Theory of Planned Behavior, computer program, counseling, error, female, health care, health care system, hospital, implantable cardioverter defibrillator, internist, interview, model, motivational interviewing, nutrition, obesity, occupation, physical activity, prevalence, qualitative research, responsibility, sampling, scientist, screening, semi structured interview, veteran",
author = "Melanie Jay and Sumana Chintapalli and Katherine Oi and M Home and Allison Squires and Kalet, {Adina L.} and Sherman, {Scott E.}",
year = "2014",
language = "English (US)",
pages = "S115",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

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TY - JOUR

T1 - Identifying barriers and facilitators to improving the implementation of weight management services within a patient-centered medical home

AU - Jay, Melanie

AU - Chintapalli, Sumana

AU - Oi, Katherine

AU - Home, M

AU - Squires, Allison

AU - Kalet, Adina L.

AU - Sherman, Scott E.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: The Veterans Affairs (VA) Healthcare System uses Patient-Aligned Care Teams (PACT) as part of its patient-centered medical home model. "Teamlets" often consist of an RN, an LPN, a program assistant, and a PCP who are tasked with screening for obesity, providing brief interventions, counseling patients, and advising eligible patients to attend MOVE!, an intensive weight management program. While every VA hospital has a MOVE! Program to address the high prevalence of overweight and obesity among Veterans, less than 10 % of eligible patients attend even one session. Since Veterans visit PACT 3.6 times per year, there are opportunities to improve counseling and service coordination. A single-center, qualitative research study of healthcare team members assessed attitudes and practices as well as elicited barriers and facilitators to care implementation for overweight and obese patients. METHODS: We recruited healthcare team members for individual key informant interviews using a combination of convenience and snowball sampling. We used a semi-structured interview guide with questions informed by the Theory of Planned Behavior. Interviews lasted 30-60 min and were conducted by a general internist in a private office while a research assistant took field notes. The interviews were audio recorded and transcribed by a transcription company. Research assistants reviewed transcripts to correct mistakes and de-identify content. Analysts then used an iterative and directed coding approach, facilitated by NVivo software and structured by an initial coding guide developed from field notes and recollections. The primary coder segmented and coded each transcript, allowing additional codes to emerge. A second researcher then independently coded each segment. The researchers met frequently to harmonize codes and synthesize themes that emerged from coded transcripts. RESULTS: There were 25 participants in the study (11MDor NP, 5 RN, 2 RD, 5 LPN, 2 Other, with 6 holding an additional managerial role); 80%were female, 48%identified as White, 28 % African American, 16 % Asian, and 8 % Hispanic. Emerging themes included: system constraints, patient barriers, and perceived role responsibility.We found that performance measures and reminders motivate and shape current practices by the PACT teamlets. Barriers to treating patients included time, competing demands, and lack of understanding about what happens in the MOVE! Program. Facilitators included having received training in motivational interviewing (MI) and having a personal interest in nutrition and physical activity. Perceptions about role responsibility varied, with some RNs, LPNs, and MDs perceiving that they play important roles in weight management counseling, while others stated that it was the role of other team members. Similarly, perceived counseling competency varied within and between the different professions. For instance, some RNs and PCPs described in great detail how they used MI to counsel patients around weight, while others questioned whether they had adequate time and training. CONCLUSIONS: These data allowed us to identify several approaches to improve weight management by the PACT teamlets and will inform the design of PACT-based weight management interventions. Findings, however, may be organization-specific, so replication of the study at other sites is necessary to determine common implementation issues.

AB - BACKGROUND: The Veterans Affairs (VA) Healthcare System uses Patient-Aligned Care Teams (PACT) as part of its patient-centered medical home model. "Teamlets" often consist of an RN, an LPN, a program assistant, and a PCP who are tasked with screening for obesity, providing brief interventions, counseling patients, and advising eligible patients to attend MOVE!, an intensive weight management program. While every VA hospital has a MOVE! Program to address the high prevalence of overweight and obesity among Veterans, less than 10 % of eligible patients attend even one session. Since Veterans visit PACT 3.6 times per year, there are opportunities to improve counseling and service coordination. A single-center, qualitative research study of healthcare team members assessed attitudes and practices as well as elicited barriers and facilitators to care implementation for overweight and obese patients. METHODS: We recruited healthcare team members for individual key informant interviews using a combination of convenience and snowball sampling. We used a semi-structured interview guide with questions informed by the Theory of Planned Behavior. Interviews lasted 30-60 min and were conducted by a general internist in a private office while a research assistant took field notes. The interviews were audio recorded and transcribed by a transcription company. Research assistants reviewed transcripts to correct mistakes and de-identify content. Analysts then used an iterative and directed coding approach, facilitated by NVivo software and structured by an initial coding guide developed from field notes and recollections. The primary coder segmented and coded each transcript, allowing additional codes to emerge. A second researcher then independently coded each segment. The researchers met frequently to harmonize codes and synthesize themes that emerged from coded transcripts. RESULTS: There were 25 participants in the study (11MDor NP, 5 RN, 2 RD, 5 LPN, 2 Other, with 6 holding an additional managerial role); 80%were female, 48%identified as White, 28 % African American, 16 % Asian, and 8 % Hispanic. Emerging themes included: system constraints, patient barriers, and perceived role responsibility.We found that performance measures and reminders motivate and shape current practices by the PACT teamlets. Barriers to treating patients included time, competing demands, and lack of understanding about what happens in the MOVE! Program. Facilitators included having received training in motivational interviewing (MI) and having a personal interest in nutrition and physical activity. Perceptions about role responsibility varied, with some RNs, LPNs, and MDs perceiving that they play important roles in weight management counseling, while others stated that it was the role of other team members. Similarly, perceived counseling competency varied within and between the different professions. For instance, some RNs and PCPs described in great detail how they used MI to counsel patients around weight, while others questioned whether they had adequate time and training. CONCLUSIONS: These data allowed us to identify several approaches to improve weight management by the PACT teamlets and will inform the design of PACT-based weight management interventions. Findings, however, may be organization-specific, so replication of the study at other sites is necessary to determine common implementation issues.

KW - human

KW - internal medicine

KW - patient

KW - society

KW - weight

KW - African American

KW - Asian

KW - Hispanic

KW - Theory of Planned Behavior

KW - computer program

KW - counseling

KW - error

KW - female

KW - health care

KW - health care system

KW - hospital

KW - implantable cardioverter defibrillator

KW - internist

KW - interview

KW - model

KW - motivational interviewing

KW - nutrition

KW - obesity

KW - occupation

KW - physical activity

KW - prevalence

KW - qualitative research

KW - responsibility

KW - sampling

KW - scientist

KW - screening

KW - semi structured interview

KW - veteran

M3 - Meeting Abstract

SP - S115

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -