Models for Delivering Weight Management in Primary Care: Qualitative Results from the MOST Obesity Study.

Background: Obesity is a leading cause of morbidity and mortality in the United States (US). Primary care medical practices can educate patients about the health effects of obesity and help patients with obesity lose and manage their weight. However, implementation of weight management in primary care is challenging.

Personal Continuous Glucose Monitoring Use Among Adults with Type 2 Diabetes: Clinical Efficacy and Economic Impacts.

Purpose Of Review: This article reviews recent clinical efficacy research and economic analysis of the use of personal continuous glucose monitoring (CGM) in type 2 diabetes (T2D).

Recent Findings: Studies from the past 5 years include a variety of randomized controlled trials, meta-analyses, and other studies which generally favor CGM over self-monitoring of blood glucose (SMBG) in T2D, especially among people with T2D treated with insulin. Concurrently, some studies show no significant difference, but there is no evidence of worse outcomes with CGM.

Expansion of telehealth curriculum: National survey of clinical education leaders.

Introduction: In response to the COVID pandemic and the rapid changes in delivery of and education on telehealth services, the Research Committee of the Alliance of Clinical Education (ACE) surveyed its multidisciplinary group of medical educators to determine how telehealth was being taught pre-COVID versus during-COVID.

Methods: An online survey was developed by the ACE Research Committee and sent via email to the ACE delegation. The objective of the survey was to determine changes in telehealth curriculum for medical students due to the rapid transition to telehealth, and the barriers for developing and delivering a telehealth curriculum.

Selected Abstracts From the Proceedings of the 2019 Society of Teachers of Family Medicine Conference on Medical Student Education.

From January 31 through February 3, 2019 the Society of Teachers of Family Medicine (STFM) held its 45th annual Conference on Medical Student Education in Jacksonville, Florida. STFM is a collaborative organization composed of members who are dedicated to teaching the discipline to learners of any level. The conference brings together members including physicians, administrators, behavioral scientists, researchers, residents, and students to learn from one another and improve the quality of family medicine education in the United States and Canada.

Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

Background: To enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.

Methods: CTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal.

Trends in Registered Dietitian Nutritionists' Knowledge and Patterns of Coding, Billing, and Payment.

The US health care system has been undergoing substantial changes in reimbursement for medical and nutrition services. These changes have offered opportunities and challenges for registered dietitian nutritionists (RDNs) to bill for medical nutrition therapy and other nutrition-related services. During the past 10 years, the Academy of Nutrition and Dietetics has periodically surveyed RDNs providing medical nutrition therapy in ambulatory care settings to learn about their knowledge and patterns of coding, billing, and payment for their services.

Colorado Residency PCMH Project: Results From a 6-Year Transformation Effort.

Background And Objectives: Our objective was to describe the results of a 6-year patient-centered medical home (PCMH) transformation program in 11 Colorado primary care residency practices.

Methods: We used a parallel qualitative and quantitative evaluation including cross-sectional surveys of practice staff and clinicians, group and individual interviews, meeting notes, and longitudinal practice facilitator field notes. Survey analyses assessed change over time, adjusting for practice-level random effects.

A Cluster Randomized Trial Comparing Strategies for Translating Self-Management Support into Primary Care Practices.

Introduction: Self-management support (SMS) is a key factor in diabetes care, but true SMS has not been widely adopted by primary care practices. Interactive behavior-change technology (IBCT) can provide efficient methods for adoption of SMS in primary care. Practice facilitation has been effective in assisting practices in implementing complex evidence-based interventions, such as SMS.

Practice Characteristics Associated with Better Implementation of Patient Self-Management Support.

Background: Advanced primary care models emphasize patient-centered care, including self-management support (SMS). This study aimed to promote the translation of SMS into primary care practices and reported on key baseline practice characteristics that may impact SMS implementation.

Methods: Thirty-six practices in Colorado and California participated in the study from December 2013 to March 2017.

Recruiting Primary Care Practices for Research: Reflections and Reminders.

Background: Recruiting primary care practices for research projects has always required carefully tended relationships, a compelling message, and good timing. Recruiting practices to participate in practice transformation research trials may take more and different efforts. We reflect on practice recruitment for a recently-concluded trial of a diabetes self-management support system in 2 states and 36 practices.

A protocol for a cluster randomized trial comparing strategies for translating self-management support into primary care practices.

Background: Advanced primary care models emphasize patient-centered care, including self-management support (SMS), but the effective use of SMS for patients with type 2 diabetes (T2DM) remains a challenge. Interactive behavior-change technology (IBCT) can facilitate the adoption of SMS interventions. To meet the need for effective SMS intervention, we have developed Connection to Health (CTH), a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients to resolve self-management problems and improve outcomes.

Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

Background: Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices.

Objective: To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR).

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

Background: Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention.

Methods: A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum.

Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in adult weight management.

Weight management encompasses the inter-relationship of nutrition, physical activity, and health behavior change. Nutrition is key for the prevention and treatment of obesity and chronic disease and maintenance of overall health. Thus, the Weight Management Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Adult Weight Management as a resource for RDNs working in weight management.

Registered dietitian nutritionists bring value to emerging health care delivery models.

Health care in the United States is the most expensive in the world; however, most citizens do not receive quality care that is comprehensive and coordinated. To address this gap, the Institute for Healthcare Improvement developed the Triple Aim (ie, improving population health, improving the patient experience, and reducing costs), which has been adopted by patient-centered medical homes and accountable care organizations. The patient-centered medical home and other population health models focus on improving the care for all people, particularly those with multiple morbidities.

Curriculum redesign for teaching the PCMH in Colorado Family Medicine Residency programs.

Background And Objectives: The patient-centered medical home (PCMH) is a practice model that is intended to improve the quality of care by making it safer, more comprehensive, integrated, and personal. However, most family medicine residency programs are not fully prepared to train residents on this idealized model. The Colorado Family Medicine Residency PCMH Project's overall objective is to transform 10 residency practices into PCMHs through practice improvement and curriculum redesign.

Patient-centered medical home: how it affects psychosocial outcomes for diabetes.

Fragmentation of the current U.S. health care system and the increased prevalence of chronic diseases in the U.

Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home.

Background: Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement.

Methods: The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care.

Overcoming early barriers to PCMH practice improvement in family medicine residencies.

Background And Objectives: Residency programs face inevitable challenges as they redesign their practices for higher quality care and resident training. Identifying and addressing early barriers can help align priorities and thereby augment the capacity to change.

Methods: Evaluation of the Colorado Family Medicine Residency PCMH Project included iterative qualitative analysis of field notes, interviews, and documents to identify early barriers to change and strategies to overcome them.

State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.

Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling.

Weight loss in a community initiative that promotes decreased energy intake and increased physical activity and dairy consumption: Calcium Weighs-In.

Background: This project addresses the need to identify feasible, effective weight-management programs that can be implemented within communities. The controversial role of dairy products in weight-management programs is also explored.

Methods: The "Calcium Weighs-In" weight-loss program placed equal emphasis on diet and physical activity and was delivered within a community intervention to promote dairy consumption in Calcium, New York.