Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting : Creating an integrated care model using telehealth

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d2702064e267">Background</h5> <p id="P1">In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d2702064e272">Objective</h5> <p id="P2">To conduct a pilot study comparing BMI changes between two arms: <i>1)</i> PCP in-person clinic visits plus obesity specialist tele-visits ( <i>PCP visits + Specialist tele-visits</i>) and <i>2)</i> PCP in-person clinic visits only ( <i>PCP visits only</i>), with ongoing tele-consultation between PCPs and obesity specialists for both arms. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d2702064e289">Methods</h5> <p id="P3">Patients (N=40, 10–17 years, BMI ≥95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + Specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d2702064e294">Results</h5> <p id="P4">Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + Specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (−0.11 vs. −0.05, P=0.049), following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (−0.11, P=0.0006) but not Group 2 (−0.06, P=0.08); however, decrease in BMI at 6 months did not differ between groups. After cross-over, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d2702064e299">Conclusion</h5> <p id="P5">An integrated care model utilizing telehealth holds promise for treating children with obesity. </p> </div>