Integrating Primary Care Practices and Community-based Resources to Manage Obesity
Chapter 5: Crossing the Bridge and Returning
The bridge is built. Now comes the part where your patient-centered interactions result in the patient going to a community-based resource that fits their need.
Even healthy people who are not overweight or obese can establish a self-management goal around diet and exercise, which should be reflected in their medical record. This would also apply to people who have managed to reduce their weight but may have gained the weight back after a year. Being focused on healthy living applies to all the patients.
Start by making patients aware that you plan to speak to them about diet and exercise. This can happen in any number of ways.
Your appointment personnel can prompt the patient that you are interested in having a brief discussion about diet and exercise at the next visit. Patients will feel more comfortable with the conversation if they know it is coming and they can prepare in advance. Here is a brief script for the scheduler to use.
"Mr. Clemente, the (name of group) is committed to helping all of our patients achieve a healthy lifestyle and to start we are focusing in on diet and exercise. I just wanted to give you a head's up that (name of clinician) will likely ask you about your goals in this area during your visit. You might want to think about little ways you can improve your diet and increase exercise before coming in."
Tool 10 (brochure) and Tool 11 (poster) can be customized with your particular information and clinic logo. The brochure may also be put in mailings to patients for other routine services such as billings, test results, and other communications. In deciding whether to include a brochure, remember to consider whether extra postage is required when the brochure is added to the mailing.
If the clinic staff is participating in attaining a healthy lifestyle, you might want to profile them on a poster in the waiting room. Have the staff member share their diet and exercise goals, which community-based resource they are using and how they are progressing. Personal stories and testimonials resonate well with consumers. And, while your staff may not be celebrities, they are known to the patients. This will also help build relationships between patients and caregivers. Further, it sends the message that you all understand the struggles and that you are all in this together.
Knowing you are not alone in the struggle is important. Your clinic may want to make a poster for the waiting area indicating the number of people who have connected with a resource. This may be a "thermometer" like those used by fundraising organizations. Setting a goal and tracking it in a transparent way will encourage staff and patients.
As part of the community inventory listing (Tool 8), we encourage clinics to develop a process to close the feedback loop. Tool 12, the community resource punch card, provides an example of one method to obtain feedback on service usage. As obesity increases health expenditures, some health insurance companies are covering or heavily subsidizing the costs for some identified diet and exercise programs. Weight Watchers tracks the attendance at their sponsored group meetings. Curves for Women has an electronic bar code admission card and a method of reporting back to insurers the utilization of those enjoying the benefit. Other private gyms may also have those tools.
For those small independent businesses not affiliated with a franchise, you may need to create some tools to allow the feedback that the patient has made the connection with the resource. Some have elected to establish a faxing system where the clinic faxes the referral and the community resource faxes a form back that the patient has used the service. Others have created punch cards to indicate the number of times the patient has been served. Tool 12 is a sample punch card. The patient can bring the tally back at their next visit. Lastly, some other resources have agreed to call the clinic to let you know your patient has connected. This does not need to be a complicated process. Your goal is to simply know that the patient followed through with your referral.
|Patients trust your judgment. A good match between an individual's characteristics (age, gender, activity interests) and the community resource (group format versus one-on-one, intensive versus casual) will help achieve desired results and may contribute to longer lasting change.|
Remember that patients trust your judgment. The services provided by the community resource will be a reflection of you and the clinic. Don't forget when the patient returns to the practice to ask them about their experience. You'll likely hear, without asking, about the negative experiences and complaints. It is important to gain knowledge of the positive experiences as well, so that you may try to direct the right patients to a resource that works better for them. A good match will last longer and achieve the desired result of a healthier lifestyle.
Community Resource Referral Rates in Our Intervention
A total of 137 patients received referrals to community-based weight management resources during a 6-week intervention period, and 81 (59.1%) were completed. Two clinics did not distribute any surveys; three sites distributed more than 25 pre-referral surveys with completion rates of 55.5%-80.7%. A total of 39 post-referral surveys were completed (48.2% response rate).
Table 10. Pre/Post Patient Surveys Distributed by Practice and Completed by Patients
a Pre-survey completion rate is equal to percent of returned out of distributed pre-surveys.
b Post-survey completion rate is equal to percent of returned post-surveys out of returned pre-surveys. Only individuals completing pre-surveys received post-surveys.