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Volume 25 (4)
Volume 25, Issue 4, Fall 2005
J Contin Educ Health Prof 2005; 25(4):259
ORIGINAL ARTICLE
Evaluation of a Training to Improve Management of Pediatric Overweight
Josephine Hinchman, MPH
Luke Beno, MD
David Dennison, MS, CHES
Frederick Trowbridge, MD, MSc
A b s t r a c t
Introduction: Despite widespread concern about pediatric obesity, health care professionals
report low proficiency for identifying and treating this condition. This paper reports on
the evaluation of pediatric overweight assessment and management training for clinicians
and staff in a managed care system. The training was evaluated for its impact on assessment
practices and utilization of management tools.
Methods: A delayed-control design was utilized to measure the effects of two 60-minute
interactive Continuing Medical education (CME) trainings for the pediatric health care
teams. Chart abstraction was conducted at 0-, 3- and 6-months after training, recording the
proportion of charts containing the recommended assessment methods and management
tools.
Results: The training was associated with a significant increase in the utilization of some
tools and practices, including charting BMI-for-age percentile (p<0.001) and using a nutrition
and activity self-history form (p<0.001). Overall, from baseline to 3-months post training,
charting BMI-for-age percentiles increased from zero to 25.2% and utilization of the
self-history form increased from zero to 35.3%. These increases were sustained at 6-months
post training. Other tools guiding clinician counseling were less widely utilized, although a
behavioral prescription pad was used with 20% of overweight patients.
Discussion: A modest investment in clinician and staff training designed to be feasible in a clinical
setting was associated with substantial increases in the use of appropriate tools and practices
for the assessment and management of pediatric overweight. Such training may help to
augment and improve the processes of pediatric health care delivery for addressing overweight.
The training provides a viable model for future CME efforts in other health care settings
Lessons for Practice
- An affordable and practical in-service training in a clinical setting can achieve substantial improvements in adherence to recommended practices for the assessment of pediatric overweight (BMI and BMI-for-age percentile)
- Attainment of similar results may be feasible and cost effective in many healthcare settings
- Reinforcement of prevention messages and the assessment and management tools may help to augment and sustain positive changes in clinical practice
- Behavioral management tools may need further modification to make them more appealing and convenient for clinician use
- Stronger messages regarding the prevention of overweight in at-risk children are needed in CME strategies
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