Communication studySatisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial
Introduction
Behavioral weight loss interventions in primary care settings have been shown to help patients lose weight and improve adverse health conditions associated with excess body weight such as hypertension and type 2 diabetes [1], [2], [3], [4], [5], [6], [7], [8]. The U.S. Preventive Services Task Force recommends that primary care providers (PCPs) “screen for obesity and offer or refer patients with a body mass index (BMI) of 30 kg/m2 to intensive, multicomponent behavioral interventions” [9], [10]. However, in practice, only about one-third of obese adults receive an obesity diagnosis, less than half are advised to lose weight, and approximately one-fifth receive counseling for weight reduction [11], [12]. Despite barriers to translating behavioral weight loss programs into practice [13], [14], [15], [16], many PCPs are interested in developing sustainable, practical strategies to promote and support patients’ weight loss efforts [16].
High quality patient–provider relationship, including trust, respect and effective communication, is associated with greater patient satisfaction and behavior change [17], [18]. However, compared to people with normal weight, people with obesity report greater doctor shopping, reduced rapport-building dialog with their PCPs and lower levels of trust in their PCPs [19], [20], [21]. Importantly, understanding the role of patient–provider relationship in primary care-based weight management is especially timely because of changes in reimbursement for obesity management in primary care settings. The Centers for Medicare and Medicaid Services (CMS) now reimburses PCPs for obesity management in primary care settings [22]. The Practice-based Opportunities for Weight Reduction (POWER) Trial at Hopkins [2] was one of three NIH-funded trials to assess behavioral interventions for weight loss in primary care settings [23]. The POWER trial documented that 2 behavioral interventions significantly reduced weight in obese patients with CVD risk factors [2]. This trial was designed for PCPs and practices to have a supportive role, including participant referral, review of weight loss progress reports at regularly scheduled clinic visits and outreach for participants who were not engaged [16]. In this context, the POWER trial provided an ideal opportunity to assess the quality of patient–provider relationships, provider characteristics and their association with weight loss.
Our main objectives were to examine whether the quality of the patient–provider relationship or patients’ satisfaction with their PCPs involvement in the intervention were associated with weight loss. Our secondary objective was to examine the associations between PCP characteristics (e.g., age, BMI) and weight loss. We hypothesized that higher quality patient–provider relationships and greater patient satisfaction with their PCPs involvement in the trial would be associated with greater weight loss.
Section snippets
Overview of the POWER trial at Johns Hopkins
Details of the study design and main results of the trial have been published previously [2], [23]. Hopkins POWER was a 3-arm randomized controlled trial evaluating the effectiveness of two 24-month practice-based behavioral weight loss interventions. For this analysis we combined the 2 intervention arms, which included the “Remote” arm with weight-loss health coaches who provided behavioral via telephone and an “In-person” arm, which provided in-person coaching, off site from the primary care
Participant characteristics
Table 1 shows the characteristics of the 347 out of the 415 participants in the POWER trial, who completed the end-of-study patient–provider questionnaires and were included in the sample. Participants attended an in-person end-of-study outcome assessment visit in order to complete this questionnaire, reducing the response rate. 239 (68.9%) were in one of the 2 intervention arms of the study. In the study sample, 62.5% were female, 39.5% were African American and 61.1% were college graduates.
Discussion and conclusion
In this study of 347 patients who participated in the POWER practice-based weight loss trial, high quality patient–provider relationship was not associated with greater weight loss. However, overall, study participants had very positive perceptions of the quality of their relationships with PCPs. The lack of variation in quality ratings likely limited our ability to discern an association with weight change outcomes. We noted that control group participants who rated the PCP highly for
Conclusion
In conclusion, our study of 347 patients enrolled in the POWER weight loss trial showed an association between high levels of participant satisfaction with the PCP role and greater weight loss. We did not detect an association between the quality of the patient–provider relationship and weight loss. In designing future practice-based models for weight loss programs, successful engagement of PCPs has potential to improve patients’ satisfaction and weight loss success.
Our results show the high
Practice implications
Our results have important implications for developing weight management programs integrated primary care settings and for the CMS policy to reimburse PCPs for weight loss counseling [22]. Our results highlight that patients in this trial highly value their providers, through their report of very high quality relationships, and that they value their PCPs involvement in their weight loss efforts. We showed that patients who most highly rated the involvement of the PCP as helpful in the weight
Disclosure
This work was supported with a grant from the Johns Hopkins University Osler Center for Clinical Excellence at Johns Hopkins. POWER Hopkins was supported by a grant from the National Heart, Lung and Blood Institute (5U01HL087085-05). The original trial's clinical trials.gov registration number was NCT00783315. Dr. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute, 5K23HL098476-02. Dr. Nae-Yuh Wang is also supported by grants from the
References (37)
- et al.
Weight loss advice U.S. obese adults receive from health care professionals
Prev Med
(2008) - et al.
Physician practice patterns of obesity diagnosis and weight-related counseling
Patient Educ Couns
(2011) Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners
Prev Med
(1995)- et al.
Patient trust in physicians and adoption of lifestyle behaviors to control high blood pressure
Patient Educ Couns
(2012) - et al.
Patients who feel judged about their weight have lower trust in their primary care providers
Patient Educ Couns
(2014) - et al.
Obese patients overestimate physicians’ attitudes of respect
Patient Educ Couns
(2012) - et al.
Primary care providers’ communication with patients during weight counseling: a focus group study
Patient Educ Couns
(2012) - et al.
Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force
Ann Intern Med
(2011) - et al.
Comparative effectiveness of weight-loss interventions in clinical practice
N Engl J Med
(2011) - et al.
Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial
J Amer Med Assoc
(2003)