Health Care Delivery System - Research Paper Example

College: Health care delivery system Introduction Justification of Research The topic chosen for this research paper is “role of primary care physicians in obesity prevention and management in the U.S.” The subject is irrefutably one of the imperative study areas in contemporary medicine and healthcare delivery system, given the fact that obesity has virtually become an epidemic around the world and particularly in the U.S. The worrisome trend calls for further research into how healthcare practitioners can aid in the mitigation process and consequent avoidance of obesity related diseases that have grown to characterize modern day America. Statistics show that approximately a third of the adult American populace is obese, and management of this significant threat to health costs an estimated $147 billion per year. It is imperative to note that, despite the extant national guidelines governing primary care physicians (PCPs) to professionally counsel obese patients on how to lose and manage their weight, a meager third of the obese patient population get weight-linked diagnoses or counseling from the physicians. This shows the need for examination of why these PCPs are not fully meeting their responsibility in obesity management. Further, even though there is progressively growing research documenting PCPs’ perspectives on obesity causative factors, there is limited information on their stance on potential solutions meant to enhance obesity management and care. Research is also scanty in regard to the roles and responsibilities borne by physicians in management of obesity. This is clearly a vital area of research, especially given the fact that primary care physicians occupy a unique position to access obese patients and provide counsel or treatment pertinent to the epidemic’s effective management. The latter position is proven by the sheer number of obese patients’ visits to PCPs, which stood at an estimated 455 million in the year 2008 and has continued to grow since. Readers’ Interest in the Research Subject It is important for people to understand the role of physicians in obesity management; as such knowledge would go a long way towards aiding advocacy for PCPs’ effective involvement. This is also a topic worth being conversant with, since obesity has widespread implications not just for the health sector, but also for social and economic spheres of the American society. Another reason that should spur people’s interest in the subject is the fact that there are currently no standardized and comprehensive measures to address obesity. This implies that, even though an individual may not be obese, he or she may suffer the downstream effects of the epidemic when attempting to gain access to proper health service. It is important to understand diverse dimensions of this subject, because it is the only way that one would comprehend PCPs’ practice patterns in obesity management and care. It also through such understanding that, individuals would become acquainted with the services to expect, if they access health facilities for counsel and assistance in weight management. The study also provides valid recommendations for enhancement of PCPs’ role in management of obesity. Emergent cohorts of medical residents and students, therefore, may have a higher likelihood of gaining information and skills pertinent to prevention, treatment, and overall management of obesity. Research Goals and Objectives The primary role of the study is to determine how effectively primary care physicians fulfil their responsibility in obesity treatment and management. This involves a detailed examination of barriers or impediments to physicians’ efficacy in meeting the stipulated responsibility. The other specific objective is to outline a set of feasible recommendations, on how the involvement of primary physicians in obesity care can be improved and bolstered. These goals are all in recognition of the notion that, there are significant gaps in PCPs’ participation in efforts to curb obesity. The study also recognizes the importance of ensuring that PCPs are well versed in evaluating patients with weight-related problems, providing proper care in a well-planned manner, and acting as advocates for the needs of obese patients, while liaising with other service providers to enhance healthcare delivery to this vulnerable societal group. Literature Review According to Sebiany (148) obesity is a serious ailment linked to enhanced patients’ risk of diverse life threatening diseases like cardiovascular disease, type 2 diabetes, hypertension, some types of cancers, and enhanced mortality. In addition, obesity has a harmful effect on the affected individuals’ quality of life. The accrual of significant healthcare costs can also not be overlooked. This is where the primary care physicians come into play, entrusted with the role of discussing and analyzing health effects of being overweight with their patients. The primary care providers are also expected to effectively manage ailments associated with obesity, while recommending proper and potentially efficient weight-loss programs. These obligations are further emphasized by Wadden (5-7), who indicates that candid communication, setting of realistic goals, and constant supervision are principal factors in execution of effective strategies of weight-loss within a primary care locale. The authors justify these PCP duties, by highlighting the notion that even though lifestyle and dietary changes are the primary line of defense while combating obesity, actual interventions by primary care physicians are necessary. This is especially the case when dealing with relatively complicated implications of excessive body weight among patients with obesity-linked comorbidities. Author Wadden (8) supports the preceding ideas, by stating that primary care physicians often encounter obese patients with weight-related ailments, impeding physical performance and other crucial metabolic procedures like cardiovascular functioning. The author is emphatic that modest loss of weight, of about 5 to 10 percent may significantly improve many complications linked to patient obesity. This effectively shows that it is highly imperative to incorporate successful physician management of patients’ obesity into the treatment of associated complications. Another literary source by Thapa et al., (356) denotes that primary care physicians usually serve as the primary source of crucial medical information about a patient. PCPs, therefore, are deemed more cost-effective and readily available than conventional dietitians and nutritionists. These primary care providers are also better equipped to make diagnoses of obesity comorbidities than usual nutrition specialists or counselors. Authors Grant, Millan, Barbara and Shahrad (33) is, however keen to note that in spite of the immense potential wielded by the PCPs in obesity treatment and management, the domain in which they operate, that is, primary health care (PHC) remains highly underutilized in pursuance of these objectives. The PHC realm has diminished capacity to manage obesity in the country because of impediments like limited consultation sessions, low patient motivation, and obese patients’ non-compliance with the proposed treatment regimen. There are also other barriers like inadequacy of teaching materials, and support services like clearly delineated obesity screening systems, as well as, insufficient training or expertise in matters concerning obesity. Barriers inhibiting primary care physicians from effectively playing their role in treatment and management of obesity have been extensively studied in literature. In addition to those mentioned in the preceding paragraph, there are physician-level impediments to obesity care. These barriers are primarily linked to the PCPs’ attitudes toward overweight patients and clinical knowledge. Such barriers include insufficient training concerning weight management and counseling of overweight patients, inadequate knowledge in obesity linked ailments hence problems during disease diagnosis, as well as, lack of skills to manage obesity. Some physicians have even reported wielding insufficient knowledge in the disciplines of nutrition and dietetics. This information deficiency impedes primary care physicians from expertly and efficiently managing obesity, to the patients’ detriment. The other significant barrier to PCPs’ involvement in effective obesity management lies in their negative attitude towards overweight or obese patients. (Zemaryalai, Tamana and Mustafa (102-105) consider the attitude problem a key contributor to low levels of success in management of obesity. This is because if primary care providers uphold a negative perception of such patients, they hesitate to treat them wholly with complete dedication. For example, care providers may perpetuate weight stigma imposed on obese individuals by mainstream society. In addition, they could be pessimistic about patients’ willingness and ability to shed some weight. Alternatively, physicians could maintain the belief that, counseling patients on the importance of weight-loss is an inefficient obesity management approach, while others may approach the treatment as though weight reduction is the patient’s responsibility in its entirety. These are undoubtedly causative factors of reduced efficiency of physicians in obesity management. Physicians should avoid these critical views of and negative attitudes toward obese individuals. This is because the negative perceptions enlarge the distance between a physician and a patient, limiting their productive interactions, while ultimately making weight management ineffective. According to Zemaryalai, Tamana and Mustafa (102-105) it is possible that primary care providers feel inadequately equipped to provide obese patients with the right mode of treatment or weight management recommendations. Some feel that the existent methods of treating or managing obesity are not effective, and essentially render their attempts futile. Sufficient training, therefore, as suggested by the author may improve physicians’ participation in weight management efforts and resultant reduction of obesity in America. Further, exploring PCPs’ awareness in matters of weight management would ensure that relevant stakeholders design unique training programs meant to effectively address knowledge deficiencies. Another barrier to primary physicians’ participation in obesity management is highlighted by Grant, Millan, Barbara and Shahrad (31), as the time that has lapsed since these healthcare professionals graduated from medical institutions or successfully completed their residency. If a long duration of time has passed since physicians completed their studies, they may feel inadequately equipped to execute obesity management regimens with utmost efficiency. The scholars are emphatic that there is a positive correlation between the number of years since medical school graduation or residency completion and negative expectations of obese patients’ outcomes, among psychiatrists, pediatricians, and other PCPs. Research also shows that primary healthcare providers may lack the competence and confidence necessary to manage obese patients and helping them improve. This is largely ascribable to lack of methodical counseling skills, poor compensation, and insufficient time with patients. Analysis and Consideration Discussion of Literary Findings Judging from the extensive analysis of literature, it is irrefutable that obese patients require help from highly qualified individuals. It is apparent that conventional weight loss programs are not sustainable and neither are they capable of achieving long-term positive outcomes in obese patients. Primary care physicians have the capability to fill this position effectively with proper training and support services to overcome extant barriers. Weight management specialists like nutritionists and dieticians may not have all the patient information necessary to guarantee efficient obesity management. In contrast, primary care physicians have the expertise to diagnose obesity-linked comorbidities. As a result, they are in a position to provide patient assessments that aid in stratification of obese patients’ risks, while highlighting the urgent need for treatment approaches that are definitive and comprehensive in nature. If properly trained on bariatric concerns, primary care physicians are also in the best placed position to holistically determine the impact of obesity on a patient. This translates to enhanced ability to address the underlying causes of obesity, whether using dietary and lifestyle, surgical, psycho-social or pharmaceutical means (Grant, Millan, Barbaraand Shahrad 34-35). Primary care physicians can also use their position and the credibility that comes with it to recognize obesity and create awareness of its effects on people’s health. Physicians’ advice makes up one of the most potent predictions of efforts made by obese patients in the attempt to lose and manage weight. Primary physicians, therefore, have a significant role to play in diagnosis and management of obesity, thus preventing its rampant spread in the American society. This makes it important for these healthcare professionals to widen the scope of their knowledge in obesity and associated ailments. Through recognition of the fact that obesity is an intricate disorder requiring long-term care and follow-up, physicians will have the ability to provide scientifically valid advice on loss of weight or weight management to obese patients. Physicians should strive to evaluate the patients for overweight as well as receiving appropriate counseling for the patients on safe weight management. Additionally, they should make sure that people are aware of the major benefits of healthy diet and physical activity. If the kind of treatment is indicated, physicians could assist patients in developing weight loss management strategies tailored towards individual needs. For instance, setting sensible weight loss objectives; picking suitable weight loss plans; patients’ referral to ancillary personnel when need be; as well as, providing monitoring, encouragement and support. Therefore, in determining the weight loss programs suitability, it is crucial for the patients and physicians to realize that the principal goal of treatment is not essentially weight loss only, but also weight management in order to achieve the best weight for health improvement. On the other hand, Physicians that engage in weight loss counseling are also supposed to take into consideration their own weight as well as set examples for the patients by practicing healthy weight management. The American Medical Association (AMA) has recommended that any individual considering taking part in weight loss programs should first consult with physician for physical examination as well as objective evaluation of the anticipated weight loss program. This is because it relates to the people’s physical condition. In case a patient needs any mode of assistance especially in counseling, physicians could utilize medical specialist’s services in dealing with the special interest in obesity treatment and registered behavior therapists, dietitians, exercise physiologists, nurses, and clinical psychologists. The Physicians have an imperative role in assisting patients in preventing obesity development by making sure that they are alerted of the risks of gaining inappropriate weight, as well as, promotion of a healthier weight lifestyle. Such efforts can start in childhood and encouraging the patients in prevention of initial development of obesity and overweight so as to avoid regaining weight after losing it. The care given to the obese patients in the hospital setting is supposed to take into consideration by such factors like outpatient clinics chair size. Additionally, the scanner capacity in radiology, maximum weight that can be held by the beds, operation tables, as well as, inpatients hoists. Specialists can concentrate on managing specific needs of the obese individuals and this could save the hospitals huge amounts of money. There is need to establish local obesity champions to highlight the issues, as well as, fulfillment of their role. Additionally, there is need to promote obesity prevention through legislation as well as working with the government and some of the food and drinks industries in promoting healthy living. Disease rates, population numbers and expenditure amounts The U.S is experiencing an epidemic in obesity and according to the Centers for Disease Control and Prevention (CDC), almost 34% of all American adults are obese. Additionally, 35% are overweight. Nearly two-thirds of the American states have obese people where more than 25% of the adult populace is obese (Thapa et al., 357). It is evident that the rate of obesity has contributed to worsening ft the health outcomes as well as health care costs explosion. Obesity and overweight signifies an increment in the risk involved developing more than twenty different diseases as well as other health issues which include hypertension, osteoarthritis, metabolic syndrome, Type 2 diabetes, cardiovascular disease, and specific cancers. Recently, a study by (Thapa et al., 358), estimates obesity to account for 9.1% annual health care spending in the U.S. This has cost the American nation approximately $147 billion. It is also evident that with the increased national attention on the economic and health costs linked with obesity has become one of the priorities especially in reducing reduce obesity (Thapa et al., 358). Due to the fact that the population has increasingly become obese, individuals between 30-35 body mass indexes have not been affected. Studies have demonstrated that almost 26% of obese individuals do not distinguish their own obesity, and the minority populaces, who have a higher rate of being obese, do not consider themselves as so. The physicians have also identified 68 percent of patients to be obese, but at the same time they have identified that less than half of the people containing a body mass index between 30 and 35 are obese (Thapa et al., 358). Correct Point Of View Based on the information presented, obesity is one of the most complex diseases in the world. Therefore, it is not surprising that numerous healthcare professionals feel overwhelmed on tackling the issues. For instance, time restrictions, as well as, lack of suitable resources are the underlying factors which have been expressed as some of the most crucial barriers to treating obesity. Additionally, some of the physicians have also highlighted inadequate training skills, as well as, support are also some of the undermining aspects that have reduced confidence in dealing with obesity. Numerous practitioners have also expressed concerns on the kind of treatment options being offered. It is therefore, understandable that in the face increasing expectations and demands placed on principal care, additional obesity management could seem daunting indeed. PCPs in general feel that there is unpreparedness in caring for obese. Many individuals have also had increased time ever since completion of medical school which could lead to more negative attitudes in dealing with obesity. This has caused a lot of frustration from years of failed attempts to assist the obese patients to lose, as well as, maintain their currently gained weight. Conclusion As discussed above, there is current need in training individuals that can efficiently deal with obesity management. Therefore, training is supposed to begin in medical schools at the foundation years, and go on throughout the core medical training aspects. Inclusion of obesity management in the training in the curricula is an imperative first step, but commonly raising obesity management awareness among the trainees in the current consultant bodies via continued medical education is also imperative. It is also crucial to take into consideration the huge predominance of obesity in the people in the hospital as well as in the community. There is need of developing a comprehensive program for training on obesity management to all key care physicians. Evidently, it is clear that with the right activities and intervention PCPs can efficiently play a huge role in treating and preventing obesity among the American citizens. Principal care providers as well as practices could need to have special arrangements in integrating obesity management and education into the office visits which are already overburdened by resource and time constraints. Numerous practices could benefit from establishing collaborative obesity management programs which fully controls any available staff as well as community resources in dealing with obesity. For instance, medical assistants, nurses, as well as, other auxiliary health professionals could be trained in provide obesity management, counseling and education. The providers could also make sure to develop evidence-based printed collection and online resources in order to fully support effective patient assessment treatment. Lists of weight-loss programs, as well as, local obesity treatment specialists and dieticians should be established in case one needs a referral. While there is a lot of information and greater education and knowledge of physicians when it comes to obesity there is need to have causation and management. More complete approaches of improving resources, self management for patients as well as healthcare structure responses would assist in completely addressing any barriers discussed. It is clear that PCPs’ outcomes on dealing with obese patients are inadequately recorded. Therefore, so as to appropriately improve obesity management, medical education is supposed to focus on enhancement of obesity-related skills. This way the PCPs will feel more confident and qualified in delivering and changing the composition of healthcare practice and teams resources. More research should therefore be done to gain sufficient information on how to offer administrative support that is availed to key care physicians within the principal health care structure. Recommendations In order to effectively deal with obesity management practices there is need to have expanded roles recommended for the PCPs. The roles include: Weight status monitoring and assessment: it is imperative for medical practitioners to regularly assess and monitor the BMI, physical activity level, nutritional intake, as well as, other indicators regarding weight status in the American populace. This will ensure that the patients suffering from obesity do not go back into indulging themselves into unhealthy eating. Promotion of Healthy lifestyle: it is important that PCPs should disseminate healthy lifestyle recommendations as well as materials as one of the major parts of key prevention efforts in the major care setting. Therefore, information on healthy lifestyle promotion should be made to be part of the patient treatment. Treatment: utilization of evidence-based methods, suchlike motivational and behavioral counseling, in the primary care setting in treating patients who are identified as obese or overweight. The treatment could include promotion of healthy lifestyle. These are some of the aspects that should be included in the treatment of obese patients. Development of Clinician skills: it is also important to included education and training on evidence-based counseling and assessment techniques. This will assist the PCPs to appropriately treat the obese patients. Development of clinical infrastructure: implementation of efficient capacity building in the primary care facilities, like improvements in organizational systems and care models utilized by providers should be established. Community program referrals: referral community-based programs for obesity should be set up for treatment obese people. These programs will also be used for community health education dissemination. Healthy lifestyle materials and recommendations should be enhanced as part of prevention efforts based on community setting. Additionally, multi-sector community initiatives, as well as, participation in the multi-sector obesity treatment and prevention initiatives in achieving the appropriate policy systems objectives should be established. The health institutions should advocate for better policies to deal with the problem. Recommendations have suggested that so as to order to efficiently diagnose, prevent, and treat obesity or overweight in the American population, clinicians should be trained adequately in standardized, counseling techniques and evidence-based assessment. In addition, clinicians should be comfortable in communicating their results on weight monitoring and assessment to the patients as well as their families. PCPs can also take on several roles especially in enhancing community health education by serving as leaders as well as providing advice to the community members. Planning, funding, evaluation and collaboration of awareness campaigns partners on marketing physical activity and healthy food choices should be implemented. PCPs are also encouraged in building partnerships with public health departments as well as colleagues, in identifying and decreasing possible barriers of obesity management. The training offered should include full spectrum in enhancing care, instead of weight assessment alone. The training can be more efficient in improving efficacy, since providers are more likely to diagnose overweight or obese by have right tools, as well as, a high comfort level in providing treatment and counseling. Therefore there is need to have the necessary training and knowledge in dealing with obesity management. Works Cited Grant, paul., Millan Piya, Barbara McGowan and Shahrad Taheri. The Bariatric Physician. Clinical Medicine, 14.1(2014): 30-35. Thapa, Rachana, Jennifer Friderici, Reva Kleppel, Jan Fitzgerald, and Michael Rothberg. Do Physicians Under-recognize Obesity? Southern Medical Association, (2014): 356-360. Zemaryalai, Tamana and Mustafa Abas. Management of adult obesity. InnovAiT, 7.2(2013), 99–108. Sebiany, Abdulaziz. Care Physicians’ Knowledge And Perceived Barriers in the Management Of Overweight and Obesity. J Family Community Med, 20.3(2013): 147–152. Wadden, Thomas, Sheri Volger, Adam G. Tsai, David B. Sarwer,Robert I. Berkowitz, Lisa Diewald, Raymond Carvajal, Caroline H. Moran, and Marion Vetter et al. Managing Obesity in Primary Care Practice: An Overview and Perspective from the POWER-UP Study. Int J Obes (Lond), 37.0 1(2013): S3–11. Read More