title: Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting.
abstract: In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity.
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Fleischman
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Hourigan
authors.affiliation: Wareham Pediatric Associates, Wareham, MA, USA.
authors.forename: H N
authors.initials: HN
authors.lastname: Lyon
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Landry
authors.affiliation: Wareham Pediatric Associates, Wareham, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Steltz
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Wareham Pediatric Associates, Wareham, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Keating
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Feldman
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Antonelli
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Ludwig
authors.affiliation: New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Ebbeling
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003153:Community Health Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D063766:Pediatric Obesity / Q000628:therapy*; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation; D017216:Telemedicine / Q000458:organization & administration
keywords: Childhood obesity; integrated care; interdisciplinary care; telehealth