Clinical Practice Gap Analysis of Obesity Treatment in the Modern Era Amy Larkin, PharmD; Karen Badal, MD, MPH Medscape Education, New York, NY Scan here to view this poster online. Methods • Obesity is a major public health crisis. In the past 10 years, prevalence in the United States has increased from 20.0% to 35.7%. 1,2 Despite recognition as a disease, obesity remains undertreated. • This study’s objective was to assess current clinical practices of primary care physicians (PCPs), endocrinologists, and obstetricians/gynecologists (OB/GYNs) in obesity management to identify knowledge, competency, and practice gaps and barriers to improving patient care. Introduction • A survey instrument was developed to assess educational needs • Included multiple choice and knowledge-and case-based questions • Made available online to healthcare providers without monetary compensation or charge Managing Obesity in Your Clinical Practice CME Challenge yourself with this clinical self-assessment on managing overweight and obese patients and see how you compare with your peers. • Part of a 4-part curriculum on obesity management on Medscape Education • Respondent confidentiality was maintained, and responses were de-identified and aggregated before analyses. • The survey launched on June 26, 2014, and participant responses were collected through July 31, 2014. Disclosure Notes Nothing to disclose. This CME-certified activity was supported by independent educational grants from Takeda Pharmaceuticals International, Inc., U.S. Region and Orexigen Source of Support Results *P <.05 Which of the following best describes your practice? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Primary care 72% (353) 7% (6) 24% (19) B Specialty medicine 9% (44) 75% (64) 56% (44) C Hospital 10% (49) 6% (5) 6% (5) D Academic/Research 2% (8) 4% (3) 3% (2) E Other 7% (33) 8% (7) 10% (8) *P <.05 Which of the following best describes your practice setting? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Private practice 54% (264) 53% (45) 56% (44) B Hospital 16% (79) 24% (20) 24% (19) C Managed care organization 7% (36) 5% (4) 3% (2) D Community health center 11% (55) 4% (3) 4% (3) E Other 11% (53) 15% (13) 13% (10) How confident are you in your ability to manage patients with obesity? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Very confident 18% (90) 21% (18) 12% (9) B Confident 46% (222) 46% (39) 33% (26) C Somewhat confident 31% (150) 26% (22) 40% (31) D Not confident 5% (25) 7% (6) 15% (12) Which of the following is the most significant barrier among physicians in the management of patients with obesity? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Lack of knowledge of current therapeutic guidelines 23% (112) 15% (13) 29% (23) B Lack of resources to educate patients 20% (96) 27% (23) 14% (11) C Lack of training 13% (65) 15% (13) 13% (10) D Lack of time 29% (140) 34% (29) 26% (20) E Physician/patient communication (eg, language barriers, cultural differences) 7% (36) 2% (2) 5% (4) F Discomfort with bringing up weight issues 8% (38) 6% (5) 13% (10) Case 1: A 50-year-old man comes to your office for follow-up. Physical examination reveals a body mass index (BMI) of 36 kg/m 2 , reflecting a gain of 15 lb since he was seen 1 year ago. His fasting blood glucose is 115 mg/dL, up from 95 mg/dL at the last visit. He has a history of cholestasis, caused by gallstones, and glaucoma. He is currently using a prostaglandin analog for his glaucoma. *P <.05 Your patient is eager to lose weight. What is a realistic initial weight loss goal for him for the next 6 months? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A 50 lb 5% (26) 1% (1) 5% (4) B Achieving a BMI below 25 kg/m 2 5% (23) 0% (0) 10% (8) C 5% to 10% of baseline weight 82% (397) 98% (83) 79% (62) D Patientʼs desired weight loss goal 8% (41) 1% (1) 5% (4) What is the mechanism of action for this medication (lorcaserin)? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Selectively targets 5-hydroxytryptamine 2C receptor 43% (210) 48% (41) 46% (36) B Stimulates norepinephrine release from hypothalamic neurons 31% (149) 28% (24) 31% (24) C Pancreatic lipase inhibitor 26% (128) 24% (20) 23% (18) *P <.05 Your patient is very excited to try this medication. He asks how much weight he will likely lose with the above medication (lorcaserin). What is the best response? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A "I can’t really say. Every patient responds differently." 15% (72) 9% (8) 14% (11) B "I would say, 10 lb is reasonable." 8% (40) 5% (4) 6% (5) C "It depends on your compliance with your lifestyle modifications, but a 10% weight loss is reasonable." 49% (241) 45% (38) 54% (42) D "We will aim for 5% in the next 12 weeks." 28% (134) 41% (35) 26% (20) Weight loss needed for clinical benefit: Mechanism of action of antiobesity agent: Efficacy expectations of antiobesity agent: Case 2: A 34-year-old female patient presents for follow-up. Her current BMI is 37 kg/m 2 . She is frustrated with her futile attempts to lose weight with lifestyle modification. She is interested in the newer medications available to assist with weight loss. She has a history of hypertension and depression. You discuss the pharmacotherapy options available and give her an overview of their risks and benefits. Due to her busy schedule and many other medications, she decides that the once-a-day option of phentermine/topiramate extended release (ER) would best suit her lifestyle. Before you consider starting her on phentermine/topiramate ER, what is an important factor in her medical history to ask about? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Statin use 9% (46) 5% (4) 8% (6) B Selective serotonin reuptake inhibitor (SSRI) use 38% (186) 29% (25) 50% (39) C Monoamine oxidase inhibitor (MAOI) use 52% (255) 66% (56) 42% (33) Your patient returns in 3 months but has only lost 1% of her baseline weight on 7.5 mg/46 mg phentermine/ topiramate ER once daily. She reports she has started walking at least a half hour nearly every day but is having trouble adhering to a low-calorie diet. You encourage her to keep records of everything she consumes with calories, for at least a week. What is the next best step regarding her medication? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Escalate dose to 15 mg/92 mg 65% (315) 75% (64) 60% (47) B Continue her at the dose she is taking 28% (138) 15% (13) 36% (28) C Refer her to a bariatric surgeon 7% (34) 9% (8) 4% (3) Which of the following dietary interventions is most successful for weight loss? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A Carbohydrate-restricted diet 15% (72) 8% (7) 23% (18) B Mediterranean style diet 16% (77) 11% (9) 9% (7) C A diet based on patientʼs preferences and medical history that achieves reduced caloric intake 63% (309) 78% (66) 62% (48) D Commercial weight loss diet 2% (11) 1% (1) 5% (4) E Low-fat diet 4% (18) 2% (2) 1% (1) Contraindications associated with antiobesity agent: Dosing and titration schedule of antiobesity agent: Successful dietary interventions: Eligibility for bariatric surgery: Confidence and Barriers: With which of the following patients would you discuss the option of bariatric surgery? PCPs (n=487) Endocrinologists (n=85) OB/GYNs (n=78) % (n) % (n) % (n) A 56-year-old woman with 39 kg/m 2 BMI with no other medical problems 8% (37) 2% (2) 6% (5) B 36-year-old man with 34 kg/m 2 BMI who does not want to try any lifestyle modifications 5% (24) 0% (0) 4% (3) C 47-year-old woman with 29 kg/m 2 BMI with comorbidities 8% (39) 13% (11) 12% (9) D 42-year-old man with 55 kg/m2 BMI unsuccessful with weight loss attempts 79% (387) 85% (72) 78% (61) Conclusion • This assessment of healthcare providers’ clinical practices identified knowledge and competency gaps among PCPs, endocrinologists, and OB/ GYNs in several key areas in the evaluation and treatment of patients with obesity. • Persistent educational gaps for all physicians: • Choosing the appropriate weight loss agent based on patient history and comorbidities • Management of patients being treated with newer weight loss agents • Safety and efficacy of newer weight loss agents • Of the barriers to treating obese patients, many could be addressed with CME, including increasing knowledge of current therapeutic guidelines, increasing access to resources to educate patients, and overcoming feelings of lack of training. • Further assessment of physicians after participating in educational interventions is planned to demonstrate improvement in clinical practice. References 1. Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system. Prevalence and trends data. 2012. http://www.cdc.gov/brfss/index.htm Last updated January 20, 2015. Accessed April 27, 2015. 2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics; 2012. For more information contact: Amy Larkin PharmD, Director of Clinical Strategy, Medscape, LLC [email protected] Demographics:
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Clinical Practice Gap Analysis of Obesity Treatment in the Modern EraAmy Larkin, PharmD; Karen Badal, MD, MPH
Medscape Education, New York, NY
Scan here to view this poster online.
Methods
• Obesityisamajorpublichealthcrisis.Inthepast10years,prevalenceintheUnitedStateshasincreasedfrom20.0%to35.7%.1,2Despiterecognitionasadisease,obesityremainsundertreated.
• Thisstudy’sobjectivewastoassesscurrentclinicalpracticesofprimarycarephysicians(PCPs),endocrinologists,andobstetricians/gynecologists(OB/GYNs)inobesitymanagementtoidentifyknowledge,competency,andpracticegapsandbarrierstoimprovingpatientcare.
Introduction
• Asurveyinstrumentwasdevelopedtoassesseducationalneeds
• Includedmultiplechoiceandknowledge-and case-basedquestions
• Madeavailableonlinetohealthcareproviderswithoutmonetarycompensationorcharge
Managing Obesity in Your Clinical Practice CME
Challengeyourselfwiththisclinical self-assessmentonmanagingoverweight andobesepatientsandseehowyou comparewithyourpeers.
• Partofa4-partcurriculumonobesitymanagementonMedscapeEducation
• Respondentconfidentialitywasmaintained,andresponseswere de-identifiedandaggregatedbeforeanalyses.
• ThesurveylaunchedonJune26,2014,andparticipantresponses werecollectedthroughJuly31,2014.
Disclosure
Notes
Nothingtodisclose.ThisCME-certifiedactivitywassupportedbyindependenteducationalgrantsfromTakedaPharmaceuticalsInternational,Inc.,U.S.RegionandOrexigen
Source of Support
Results
*P <.05
Which of the following best describes your practice?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Primary care 72% (353) 7% (6) 24% (19)
B Specialty medicine 9% (44) 75% (64) 56% (44)
C Hospital 10% (49) 6% (5) 6% (5)
D Academic/Research 2% (8) 4% (3) 3% (2)
E Other 7% (33) 8% (7) 10% (8)
*P <.05
Which of the following best describes your practice setting?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Private practice 54% (264) 53% (45) 56% (44)
B Hospital 16% (79) 24% (20) 24% (19)
C Managed care organization 7% (36) 5% (4) 3% (2)
D Community health center 11% (55) 4% (3) 4% (3)
E Other 11% (53) 15% (13) 13% (10)
How confident are you in your ability to manage patients with obesity?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Very confident 18% (90) 21% (18) 12% (9)
B Confident 46% (222) 46% (39) 33% (26)
C Somewhat confident 31% (150) 26% (22) 40% (31)
D Not confident 5% (25) 7% (6) 15% (12)
Which of the following is the most significant barrier among physicians in the management of patients with obesity?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Lack of knowledge of current therapeutic guidelines 23% (112) 15% (13) 29% (23)
B Lack of resources to educate patients 20% (96) 27% (23) 14% (11)
C Lack of training 13% (65) 15% (13) 13% (10)
D Lack of time 29% (140) 34% (29) 26% (20)
EPhysician/patient communication (eg, language barriers, cultural differences)
7% (36) 2% (2) 5% (4)
F Discomfort with bringing up weight issues 8% (38) 6% (5) 13% (10)
Case 1:
A 50-year-old man comes to your office for follow-up. Physical examination reveals a body mass index (BMI) of 36
kg/m2, reflecting a gain of 15 lb since he was seen 1 year ago. His fasting blood glucose is 115 mg/dL, up from 95
mg/dL at the last visit. He has a history of cholestasis, caused by gallstones, and glaucoma. He is currently using a
prostaglandin analog for his glaucoma.
*P <.05
Your patient is eager to lose weight. What is a realistic initial weight loss goal for him for the next 6 months?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A 50 lb 5% (26) 1% (1) 5% (4)
B Achieving a BMI below 25 kg/m2 5% (23) 0% (0) 10% (8)
C 5% to 10% of baseline weight 82% (397) 98% (83) 79% (62)
D Patientʼs desired weight loss goal 8% (41) 1% (1) 5% (4)
What is the mechanism of action for this medication (lorcaserin)?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Selectively targets 5-hydroxytryptamine 2C receptor 43% (210) 48% (41) 46% (36)
BStimulates norepinephrine release from hypothalamic neurons
31% (149) 28% (24) 31% (24)
C Pancreatic lipase inhibitor 26% (128) 24% (20) 23% (18)
*P <.05
Your patient is very excited to try this medication. He asks how much weight he will likely lose with the above medication (lorcaserin). What is the best response?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A "I can’t really say. Every patient responds differently." 15% (72) 9% (8) 14% (11)
B "I would say, 10 lb is reasonable." 8% (40) 5% (4) 6% (5)
C"It depends on your compliance with your lifestyle modifications, but a 10% weight loss is reasonable."
49% (241) 45% (38) 54% (42)
D "We will aim for 5% in the next 12 weeks." 28% (134) 41% (35) 26% (20)
Weight loss needed for clinical benefit: Mechanism of action of antiobesity agent: Efficacy expectations of antiobesity agent:
Case 2:
A 34-year-old female patient presents for follow-up. Her current BMI is 37 kg/m2. She is frustrated with her futile attempts to lose weight with lifestyle modification. She is interested in the newer medications available to assist with weight loss.
She has a history of hypertension and depression. You discuss the pharmacotherapy options available and give her an overview of their risks and benefits. Due to her busy schedule and many other medications, she decides that the once-a-day
option of phentermine/topiramate extended release (ER) would best suit her lifestyle.
Before you consider starting her on phentermine/topiramate ER, what is an important factor in her medical history to ask about?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Statin use 9% (46) 5% (4) 8% (6)
B Selective serotonin reuptake inhibitor (SSRI) use 38% (186) 29% (25) 50% (39)
C Monoamine oxidase inhibitor (MAOI) use 52% (255) 66% (56) 42% (33)
Your patient returns in 3 months but has only lost 1% of her baseline weight on 7.5 mg/46 mg phentermine/topiramate ER once daily. She reports she has started walking at least a half hour nearly every day but is having trouble adhering to a low-calorie diet. You encourage her to keep records of everything she consumes with calories, for at least a week. What is the next best step regarding her medication?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Escalate dose to 15 mg/92 mg 65% (315) 75% (64) 60% (47)
B Continue her at the dose she is taking 28% (138) 15% (13) 36% (28)
C Refer her to a bariatric surgeon 7% (34) 9% (8) 4% (3)
Which of the following dietary interventions is most successful for weight loss?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A Carbohydrate-restricted diet 15% (72) 8% (7) 23% (18)
B Mediterranean style diet 16% (77) 11% (9) 9% (7)
CA diet based on patientʼs preferences and medical history that achieves reduced caloric intake
63% (309) 78% (66) 62% (48)
D Commercial weight loss diet 2% (11) 1% (1) 5% (4)
E Low-fat diet 4% (18) 2% (2) 1% (1)
Contraindications associated with antiobesity agent:
Dosing and titration schedule of antiobesity agent:
Successful dietary interventions:
Eligibility for bariatric surgery:
Confidence and Barriers:
With which of the following patients would you discuss the option of bariatric surgery?
PCPs(n=487)
Endocrinologists(n=85)
OB/GYNs(n=78)
% (n) % (n) % (n)
A56-year-old woman with 39 kg/m2 BMI with no other medical problems
8% (37) 2% (2) 6% (5)
B36-year-old man with 34 kg/m2 BMI who does not want to try any lifestyle modifications
5% (24) 0% (0) 4% (3)
C 47-year-old woman with 29 kg/m2 BMI with comorbidities 8% (39) 13% (11) 12% (9)
D42-year-old man with 55 kg/m2 BMI unsuccessful with weight loss attempts
79% (387) 85% (72) 78% (61)
Conclusion •Thisassessmentofhealthcareproviders’clinicalpracticesidentifiedknowledgeandcompetencygapsamongPCPs,endocrinologists,andOB/GYNsinseveralkeyareasintheevaluationandtreatmentofpatientswithobesity.
• Persistenteducationalgapsforallphysicians:
• Choosingtheappropriateweightlossagentbasedonpatient historyandcomorbidities
• Managementofpatientsbeingtreatedwithnewerweightlossagents
• Safetyandefficacyofnewerweightlossagents
• Ofthebarrierstotreatingobesepatients,manycouldbeaddressedwithCME,includingincreasingknowledgeofcurrenttherapeuticguidelines,increasingaccesstoresourcestoeducatepatients,andovercoming feelingsoflackoftraining.
• Furtherassessmentofphysiciansafter participatingineducationalinterventionsis plannedtodemonstrateimprovementinclinical practice.
References
1. Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system. Prevalence and trends data. 2012. http://www.cdc.gov/brfss/index.htm Last updated January 20, 2015. Accessed April 27, 2015.
2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics; 2012.
Formoreinformationcontact: AmyLarkinPharmD,DirectorofClinicalStrategy,Medscape,LLC [email protected]
Demographics:
Related Documents
