FEATURE | Posted Dec. 18, 2013

HEALTH-COP: Uniting with rural physicians to fight childhood obesity

A virtual learning and quality-improvement network to bolster rural physician patient care

Dr. Ulfat Shaikh
Ulfat Shaikh, M.D.

Using telemedicine to unite primary-care providers at rural health clinics with specialists at UC Davis can help stem the rising tide of childhood obesity in remote, isolated California communities, where children and teens are at the greatest risk of becoming overweight or obese, because they lack access to healthy foods and opportunities for physical activity.

“Obesity prevention and management can be particularly challenging in rural areas,” said Ulfat Shaikh, director of Healthcare Quality in the UC Davis School of Medicine. “Families don’t have as much access to walking paths, play facilities and places to buy healthy food, putting kids at risk for diseases such as hypertension, type 2 diabetes and depression. There may be only one grocery store in town and that store may not include an array of healthy options.”

Primary-care physicians who see patients in isolated areas often are isolated and lack the peer support that can lead to better patient care, such as the availability of continuing medical education — a high priority for doctors in rural communities.

A new approach: HEALTH-COP

To provide these and other resources to rural physicians, Shaikh and her collaborators created HEALTH-COP — Healthy Eating Active Living TeleHealth Community of Practice — to improve health in rural communities statewide.

HEALTH-COP was a pilot virtual learning and quality-improvement network that reached out to seven clinics throughout rural California that serve diverse patient populations. One is located in Imperial County on the California-Mexico border; another is in Humboldt County near California’s border with Oregon.

Through live video conferencing and other methods, HEALTH-COP taught rural clinicians how to better assess patients’ weight; provide counseling on nutrition and physical activity; reorganize clinics to provide better care; screen for risk factors and implement strategies to effectively discuss body weight.

“Sometimes families broach the issue, but other times they are in denial,” Shaikh said. “We provided instruction on motivational interviewing to help change lifestyle behavior. Teams were taught to assess where the family is and help them with their decision making.”

Providing new tools for health counseling

The combination of clinical materials, education and peer support had a major impact on care, Shaikh and her colleagues found. The Davis team looked at clinical practices, both before and after the program was implemented, and scored clinicians on their abilities to document their patient’s BMIs and other weight measures, counsel patients and families on healthy lifestyles and provide family-centered care. Over time, the clinicians’ mean score increased from 3.5 to 4.6 on a 0-to-5 scale.

Child has weight meaured
HEALTH-COP taught rural clinicians how to better assess patients’ weight.

Shaikh and her colleagues also examined family perceptions, surveying parents during their children’s clinic visits. The survey asked whether they had been counseled on a number of issues related to diet, screen time and physical activity. The results showed that clinicians increased the number of topics they covered. In particular, they expanded their counseling on watching television, drinking sugary drinks, sitting down to meals as a family and eating fruits and vegetables.

The clinics were given lists of community resources such as affordable foods, after-school programs and support services, to point families in the right direction. They also received charts, posters, BMI wheels and other materials. In addition, the network provided access to the latest care guidelines from the American Academy of Pediatrics and other resources.

Perhaps the most useful innovation was the connectivity between clinics, Shaikh said. Peer support amongst rural clinicians allowed them to share experiences and knowledge, customize materials such as parent-education handouts, and find creative ways to improve access for their patients.

“As an urban pediatrician, if I can’t figure out a problem, all I have to do is find a colleague in the building where I work and ask their impressions,” Shaikh said. “By setting up this network, we made it easier for rural clinicians to do the same. Regardless of where they are in California, they all face similar problems. Now, they can share solutions.”