Date of Award

4-1-2019

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Natalie Eddy

Abstract

The United States is amid an obesity epidemic (Institute of Medicine, 2012). Indiana ranks as the tenth most overweight state. (America’s Health Rankings, 2018). Despite guidelines outlining the treatment of obesity, primary care providers seldom use these guidelines (Hayes et al., 2017). In a 2010 study, only 28.9% of obese patients received a diagnosis of obesity and less than 25% of these patients received counseling on diet, exercise, or weight loss (Bleich, Pickett-Blackely, & Cooper, 2011). The purpose of this evidence-based practice (EBP) project is to determine if a multi-faceted intervention consisting of academic detailing, reminders, audit with feedback, and frequent communication will increase the rate of diagnosis and treatment of patients with overweight and obesity in primary care. This EBP project is supported by evidence from eight high quality sources. Utilizing the Stetler Model and Lewin’s Change Model, this EBP project enrolled 13 advanced practice registered nurses (APRNs) employed at hospital-owned, primary care clinics located throughout a Midwestern State. Descriptive statistics were used to compare data obtained retrospectively through a 2-week chart review pre- and post-intervention. The pre- and post-intervention groups were analyzed by age, gender, and BMI. There were no statistically significance differences between the two groups. Utilizing one-tailed z-scores, statistical significance was found in two of the four the primary outcomes. There was an increase in diagnoses after the multi-faceted intervention in patients with overweight (z = -1.8, p = .04). There was also an increase in documented treatment post intervention in patients with obesity (z = -2.23, p = .01). Secondary outcomes examined the providers’ knowledge, beliefs and feeling regarding overweight and obesity. Statistical analyses using two-tailed Wilcoxon’s Signed-Ranks Test compared survey results pre- and post intervention. There were statistically significant results in five survey questions. All questions were on a four-point Likert scale. The questions with statistical significance were: familiarity with the ACCE guideline (z =-2.12, p = .03) and the Endocrine Society guideline (z = -2.27, p = .02), significance of available resources to refer overweight and obese patients (z =-2.17, p = .03), belief that patients are responsible for their own weight management (z = -2.45, p = .01), and influence of new weight loss drugs on referral to bariatric surgery (z = -2.16, p= .03). While the results of this EBP project were mixed, this project lends support for use of a multi-faceted intervention targeting providers to increase diagnosis and treatment of overweight and obesity in primary care.

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