Obesity Screening Training Using the 5AS Framework

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Obesity Screening Training Using the 5AS Framework

Introduction

The learning objectives of this project include applying a practice improvement project in a real-life setting and collecting and analyzing the results. Additionally, another objective is the implementation of best practices to address a serious healthcare concern, such as obesity in a clinical setting. Finally, this project allowed one to learn how to use best practices in obesity management to help patients.

Obesity is a serious health concern in the United States, both due to its impact on the health and well-being of the patients and because this condition places a substantial burden on the healthcare system. The CDC (2018) reports that 39% of the American population was obese in 2016. Moreover, obesity results in $147 million in healthcare expenditures per year (CDC, 2018). Apart from this, obesity results in several comorbidities that affect the patients health, and this condition is linked to premature mortality.

Problem Statement

Primary care providers (PCPs) can help patients modify their habits and diet to decrease the latters weight; however, in many cases, they are not trained to do this and do not possess the tools needed for such an intervention.

This obesity management DNP targets primary care providers (PCP) and utilizes the 5A framework. The goal is to help PCP providers screen patients and monitor the latters BMI to achieve a reduction of the BMI that would be substantial for the improvement of the patients health and quality of life. Brown and Perrin (2018) advise administering intervention programs as an effective tool and framework for PCPs when they are working with obese patients. Other issues that obese patients face are loss of productivity, higher rates of unemployment when compared to individuals with normal BMI, and social challenges (Blüher, 2019). Hence, obesity has a significant effect on the patients social life and affects their ability to participate in normal activities.

Purpose

The purpose of this paper is to decrease obesity levels at the community level. This goal is achieved by providing the PCPs with the tools, skills, and knowledge that would allow them to identify patients who require intervention and help them restructure their habits and diet to decrease weight. Since obesity is a serious healthcare concern for patients and impairs their health and well-being, the PCPs who come in direct contact with these individuals should be trained to address this issue. Moreover, this intervention project intends to address obesity at a community level since this problem affects a significant portion of the United States population.

Literature Review

To prepare for this DNP, the author searched through the scientific literature that provides the best practices for helping patients manage their weight. Studies by Welzel et al. (2018) and Fitzpatrick et al. (2016) outline the necessity for PCPs training on obesity management. Next, the 5A framework is disclosed in studies by Van Dillen et al. (2015) and Sherson et al. (2014) about obesity management. 5A frameworks application in training the PCPs was studied by Welzel et al. (2018). Finally, the 5As significance for patient weight loss was addressed in studies by Moyer (2012). In general, the literature supports the contribution of the 5A framework for the decrease of weight in patients when applied by PCPs.

Some of the facts from the literature help us understand the 5A framework and its application in clinical practice. PCPs support for patients who struggle with obesity is vital as they have the expertise to diagnose and guide these individuals through behavioral change. For example,

Welzel et al. (2018) report that individuals who have received counseling from their PCP feel more confident and achieve better results when working on behavioral change to support their weight reduction. Moreover, since 2011 providers have been reimbursed for their obesity management programs by the Center for Medicare and Medicaid Services (Fitzpatrick et al., 2016). Other organizations that support research and practice interventions for addressing heart disease, diabetes, and other comorbid conditions have also supported the PCPs initiatives regarding the implementation of obesity management interventions. Moyer (2012) recommends screening all adult patients and assigning them to an obesity management program if their BMI exceeds 30kg/m2.

Methods

This study was conducted in a clinical setting, more specifically, in a community well-being clinic located in Date County, Florida. The pre/post-test quantitative design was used because it allowed comparing the results before and after the intervention. Data was collected through surveys distributed to the PCPs before and after the training sessions. Each of the PCPs participated in 4 training sessions, each lasting for 90 minutes. In total, 20 PCPs from the clinic took part in the training sessions, and a non-probability sampling method was used to select the participants.

Intervention

The first step was to raise awareness of PCPs on topics of addressing obesity or treating it without the use of an appropriate clinical standard. Here, the PCPs were educated on the problem of obesity trends and the availability of interventions such as the 5 As model. PCP Training on how to use 5 As Framework for obesity screening:

a simple pneumonic device consisting of five elements: assess, advise, agree, assist, and arrange.
follows a sequence of evidence-based practice actions
type of behavioral counseling which can be delivered in a primary care setting
shown to be effective in helping patients improve health behaviors.

The second step of the intervention entailed coaching and training of the PCPs on techniques of the 5 As a model. Each training session was dedicated to a specific element of 5A and behavioral change. The skills taught in these intervention steps included methods of patient screening for obesity during routine checkups, communicating the need for an intervention, and applying behavioral change and counseling. The last intervention step required monitoring to ensure that the new standard of care has been successfully established and fully integrated. The success of the intervention has subsequently been comparatively analyzed.

Data Collection/Instrumentation

The data was collected from two sources, the first one is the responses of the PCPs before and after the intervention and the second is the patients data, taken from the records and their weight recorded after the intervention. The survey questions included general information about the PCPs training and background as well as information about their knowledge of behavioral change practices. Apart from this, the researcher collected data on patients, mainly their BMI, that allowed for assessing the effectiveness of this intervention and the effect of it on their weight loss.

Study Limitations

The main limitation of this study is the small sample size. Since the study was conducted in one small clinic in Florida, the results might be biased. Studies with larger samples would allow confirming the results of this project further. Additionally, the sampling technique could mean that the study subjects were biased, and therefore, further studies are needed to confirm the results.

Results: Details

In the post-test, 90% of PCPs took part in the training sessions. Concerning the first aim of increasing primary providers obesity screening knowledge and skills, the study showed that training of PCPs on the use of 5As was effective at increasing providers skills, knowledge, and competencies about the screening and counseling of patients with obesity.

Before the intervention, a majority of the healthcare providers either rarely, never, or only sometimes screened for obesity in adult patients they encountered while providing primary care. After the training intervention, 80% of PCPs said they always screened adults for obesity when providing primary care; representing an improvement of 55% from 25% before the intervention.

Questions on the ask investigated competencies in behavioral and physical examination, measuring BMI, and determining readiness to change among patients with obesity. After the intervention, all participants (100%) reported having good to excellent abilities in taking a targeted history of the patient and conducting a physical examination to identify common co-morbidities. This was an increase from 55% pre-interventions.

Three questions addressed the advice component of the 5As framework. These were discussing the risk and effects of obesity on the patients present and future, discussing the benefits of weight loss to the patient, and responding to patients questions regarding treatment options. Post-intervention, all healthcare providers reported either being able to perform well or being able to teach others how to perform all questions in the advice component.

For the Agree component, one question was used to assess competency in assessing patients physical activity and guiding them to set effective physical activity goals. There was an increase of 45% increase in PCPs ability in the agree competency

Concerning the Assist component, four competencies were investigated pre and post-intervention. There was an increase in the providers knowledge and skills in all competencies tested including the use of motivational interviewing to change behavior, provision of weight-loss counseling, and determining the need for additional help such as pharmaceuticals and surgery

Lastly, competencies in the arrange component were assessed using two questions on the referral of patients with psychological problems and collaboration with other professionals, and the use of community resources to assist patients to lose weight. Like other components, there was an increase in competency post-intervention with an 80% and 85% increase for both competencies.

Results

An overall group improvement was recorded from the pre-intervention to post-intervention for the PCPs. This was a statistically significant improvement thus confirming that training of PCPs on the implementation of the 5As framework in obesity management is effective at improving their knowledge and skills and reducing the BMIs of their patients with obesity.

There was an increase in competency in all five components of the 5 As framework including asking, advising, agreeing, assisting, and arranging as outlined in the results. In terms of knowledge and skills application, 92.5% ± 0.71 of PCPs could screen, counsel, and treat patients with obesity and were competent with 5As framework for patients with obesity after the intervention.

In addition, post-intervention had an improvement on patients 42.5% who experienced a reduction in body weight loss due to direct involvement of PCPs in their treatments.

Implications

The findings of this DNP suggest that teaching PCPs how to understand and apply the 5A framework is an effective way to improve their knowledge of obesity management techniques. As a result, educating new PCPs and those who have previously worked in a facility is recommended as an effective obesity management tool. Furthermore, the findings of this DNP highlight the necessity of disseminating knowledge to PCPs and tracking patient outcomes as a means of ensuring the facilitys obesity-management methods are efficient. The patients BMI is monitored regularly to ensure that the management techniques in place are helping these patients accomplish their health and wellness goals. As a result, this DNP can be utilized as a model for other facilities that need to handle the same issues.

Conclusion

In summary, obesity can be managed at a community level if providers employ screening methods and use the 5A framework to guide and support the patients. Under this study, the participants achieved a reduction of weight, measured six months after the research was completed. Additionally, the providers knowledge of obesity management practices has improved substantially. Hence, the study has been successful and has helped improve the current practices at the clinic.

References

Blüher, M. (2019). Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15, 288-298.

Brown, C. L., & Perrin, E. M. (2018). Obesity prevention and treatment in primary care. Academic Pediatrics, 18(7), 736-745.

Center for Disease Control and Prevention. (2018). Adult obesity facts. Center for Disease Control and Prevention.

Gleichmann, N. (2020). Paired vs unpaired t test: Differences, assumptions and hypotheses. Technology Networks. Web.

Moyer, V. A. (2012). Screening for and management of obesity in adults: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 157(5), 373-378.

Welzel, F. D., Stein, J., Pabst, A., Luppa, M., Kersting, A., Blüher, M., & Riedel-Heller, S. G. (2018). Five As counseling in weight management of obese patients in primary care: A

Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewins theory with leans system approach for change. Online Journal of Issues in Nursing, 21(2).

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