Aligning Clinical Practice with Evidence: Primary Care Pediatricians’ Perspectives on Standardizing Obesity Management

Abstract

Purpose

A Quality Improvement (QI) initiative was implemented to improve evidence-based pediatric obesity related clinical care. We evaluated changes in clinicians’ knowledge and confidence and their perception of improvements and challenges in obesity-related clinical care post-QI implementation.

Approach

The study included pre and post-intervention self-report surveys, semi-structured qualitative interviews, and randomized chart reviews.

Setting

The setting was two primary care centers in Washington, DC between March 2021-March 2022.

Participants

Of the 42 clinicians offered multi-modal interventions, 33% completed both surveys. Of the 17 clinicians offered a qualitative interview, 15 were completed (88%).

Method

Quantitative analysis was conducted using McNemar’s exact test and qualitative data underwent thematic analysis.

Results

Data analysis demonstrated an overall positive and significant change in clinician confidence in diagnosing and managing pediatric obesity (Χ² = 12.0, P = 0.0005). The post-intervention thematic analysis of semi-structured clinician interviews identified three major themes: (1) improvement in clinical obesity management, (2) barriers to effective clinical obesity management, and (3) deeper self-reflection of obesity stigma on clinical weight management.

Conclusions

While barriers exist in managing obesity within medical homes, the implementation of a targeted QI initiative may improve pediatric clinicians’ confidence in providing evidence based culturally competent care.