Background: Childhood obesity is a growing epidemic. According to the Center for Disease Control and Prevention (CDC) the prevalence of childhood obesity is 18.5%, affecting 13.7 million children and adolescents. Treatment for obesity often requires a significant amount of time and close follow-up with patients and their families to affect long-term health. It is widely recognized that there is limited effectiveness in addressing excessive weight at a single office visit due to physician barriers, such as a lack of time to address obesity during routine office visits, a lack of reimbursement, inadequate training and low self-efficacy in handling patients of excess weight. Effective weight management requires an integrated team approach and medicine is moving towards treating obesity as a specialty. At St John’s Well Child & Family Center, a referral process to an obesity medicine specialist (American Board of Obesity Medicine certified) was created to allow primary care physicians (PCP) to refer pediatric patients struggling with obesity and/or comorbidities.
Objective: To establish a referral process at St. John’s Well Child & Family Center
- Created documents and discussed plans for referrals, visits, and publicity to other providers.
- Met with the Referrals Department, IT Department & Call Center
- Met with the CMO and the Director of Operations to discuss the feasibility of developing a referrals process.
- Created an outline for a referrals process in the EMR and established a template for specialist consultation and follow up visits
Results: We created steps for primary care providers to refer patients to an in-house obesity medicine specialist. The patients to be referred are those that have a Body Mass Index (BMI) at or above the 95thpercentile or a BMI at or above the 85thpercentile and have significant comorbidities (i.e. HTN, Elevated LFTs, grossly abnormal cholesterol, etc.). An appointment template to include 30 minutes of consultation time for initial visit and 15 minutes for follow-up visit was implemented. Forms such as initial history form, off label drug use consent form, appointment reminder letter, and letter for missed appointment were also created. Finally, we initiated the process with the IT department to create a provider note template in the EMR to aid the obesity specialist with documentation and referral management.
Conclusion: Effective weight management requires a team approach. A physician specializing in obesity serves as a resource for children living with obesity and comorbidities. Implementation of this referral process may allow for community clinics and their providers to improve the treatment and quality life of their patients.