Scaling-Up Stage 4 Pediatric Obesity Clinics: Identifying Barriers and Future Directions Using Implementation Science.
Faith Anne N HeerenAbhaya DilipSarah C ArmstrongRamzi G SalloumMichelle I CardelPublished in: Obesity (Silver Spring, Md.) (2021)
Nearly one-fifth of the pediatric population in the United States has obesity. Comprehensive behavioral interventions, with at least 26 contact hours, are the recommended treatment for pediatric obesity; however, there are various barriers to implementing treatment. This Perspective applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to address barriers to implementing multidisciplinary pediatric weight management clinics and identify potential solutions and areas for additional research. Lack of insurance coverage and reimbursement, high operating costs, and limited access to stage 4 care clinics with sufficient capacity were among the main barriers identified. Clinicians, researchers, and patient advocates are encouraged to facilitate conversations with insurance companies and hospital and clinic administrators, increase telehealth adoption, request training to improve competency and self-efficacy discussing and implementing obesity care, and advocate for more stage 4 clinics.
Keyphrases
- primary care
- quality improvement
- weight loss
- insulin resistance
- metabolic syndrome
- healthcare
- weight gain
- affordable care act
- high fat diet induced
- type diabetes
- palliative care
- health insurance
- physical activity
- body mass index
- skeletal muscle
- case report
- pain management
- risk assessment
- electronic health record
- young adults
- current status
- climate change
- chronic pain
- long term care
- molecularly imprinted
- childhood cancer
- solid phase extraction