IN4Kids: data from a study of RD integration into primary care
Kolasa, Kathryn M.; Silberberg, Mina; Carter-Edwards, Lori; Murphy, Gwen; Mayhew, Megan; Armstrong, Sarah; Perrin, Eliana; Vodicka, Sheree; Graham, Cameron; Shah, Vandana
Research indicates barriers to PCPs recognizing and counseling overweight children and their families, including lack of: knowledge about nutritional guidance, time to provide services, reimbursement, and skills in working with overweight children. Integrating a registered dietitian (RD) into primary care may help address these issues. METHODS: As part of the IN4Kids study, 272 primary care practice staff and providers at 13 primary care practices in North Carolina were surveyed to assess comfort, confidence, and perceived effectiveness in treating overweight children; knowledge of RD services and perceived benefits of RD integration; and awareness and use of NICHQ guidelines. Select comparisons by respondents’ role at the practice and having a dietitian on staff were assessed using Chi-square tests. RESULTS: Overall, respondents were most comfortable and confident recommending nutritional resources to parents and with their practice’s capacity to make changes to better address childhood obesity. They were least comfortable and confident with knowledge of billing for obesity as a diagnosis. Few (<6%) felt highly effective in all areas of treating childhood overweight, but respondents at practices with an RD were more likely to report comfort, confidence, and perceived effectiveness in dealing with overweight children. Respondents understood that RDs can discuss food choices with patients and parents, and create a nutrition plan. They also felt that having an RD in a practice greatly improves weight management and provides more time for nutritional counseling. Providing another set of billable visits was perceived to be the least important benefit of having an RD; staff in practices with an RD were more likely to know that RDs can bill independently (71.9% v. 50.2%, p<.05). Awareness of the NICHQ guidelines was low (20.5% overall). However, staff at practices with an RD were more aware of NICHQ guidelines than those at practices without an RD (37.5% vs. 17.9%, p<.05); and providers and management staff were more aware than staff in other roles (32.8% vs. 16.6%, p<0.05). CONCLUSIONS: Although primary care practices feel comfortable and confident in several areas of childhood overweight treatment, perceived effectiveness in these areas remains low, as is awareness of NICHQ guidelines around the treatment of childhood obesity. The presence of an RD is associated with greater comfort, confidence, effectiveness, and awareness relative to several aspects of treating childhood overweight. The financial viability of RD integration into primary care is not well understood; further exploration in this area is needed.