Darwin Deen

Implementation of a pilot primary care lifestyle change intervention for families of pre-school children: Lessons learned

OBJECTIVE We used Glasgows RE-AIM framework to evaluate the feasibility of a primary care-based intervention to decrease behaviors that place urban children at risk for obesity. METHODS During preventive visits of 2-5-year olds between February 2006 and May 2007, parents completed a health behavior assessment. Primary care providers engaged parents in brief goal setting and referred them to a lifestyle counselor. Evaluation involved medical record review, interviews with staff and clinicians, and health behavior assessment via a pre- and post-intervention telephone survey. RESULTS Families reached by the intervention did not differ from families who were not. The intervention was adopted by 14 of 17 clinicians. The health assessment was implemented in 32% of preventive visits (N=354). Of those, goal setting by physicians occurred in 59%, with 55% referred to the lifestyle counselor. We were unable to demonstrate effectiveness to change adult or child nutrition or physical activity, as complete data were available for only 34 families. CONCLUSION Goal setting with referral for more intensive lifestyle counseling for obesity prevention in high risk families is feasible and acceptable in primary care. PRACTICE IMPLICATIONS Patient educators can be integrated into primary care to achieve preventive care goals.

A mini‐fellowship in clinical nutrition for primary care physicians

When the Regional Nutrition Centers (RNCs) mini-fellowship was being developed, physicians teaching in medical schools and residency programs had little formal training in nutrition, so it was difficult to identify faculty to serve as role models and clinical preceptors. Using funds provided by an NIH/NCI R-25 grant, the mini-fellowship in clinical nutrition was developed as a model to meet the nutrition education needs of senior residents and junior faculty in primary care disciplines. It provided a brief but broad exposure to clinical nutrition topics, with a focus on issues relevant to the practice of primary care and teaching skills. In four weeks, fellows completed didactic course work, a clinical preceptorship, and a teaching project. Tracking of the 55 physicians who completed the program by questionnaires has shown significant improvement in their nutrition-related patient care activities.