Implementing a Virtual, Collaborative Care Weight Management Program in Rural Primary Care: Pilot Results and Insights.

Abstract

Background: Obesity rates have reached epidemic levels globally, and still, rates of overweight and obesity in South Carolina (SC) remain disproportionately high compared with national statistics. Further, those living in rural areas are at an increased risk of experiencing obesity with limited access to weight management programs, such as specialized nutrition counseling and lifestyle behavior change programs. Collaborative care management (CoCM) is an evidence-based approach that leverage a multidisciplinary team to treat specialized conditions within primary care, most often implemented to manage mental and behavioral health conditions. To our knowledge, the Primary Care Integrated Weight Management program (PCIWM) is the first to adapt CoCM model for weight management.The purpose of this study is to (1) describe pilot PCIWM implementation and (2) identify strategies to improve adoption and inform sustainability.

Methods: A multidisciplinary care team-including Registered Dietitians Nutritionists (RDNs), primary care providers (PCPs), practice managers, and a weight management consultant-was established to develop a PCIWM workflow and patient registry within an academic medical center and four affiliated rural primary care clinics. The PCIWM workflow involved RDN documentation, routing encounter notes to PCPs, monthly consultations between RDNs and weight management consultants, and between-session surveys.Adult patients with weight-related concerns, particularly those with a body mass index (BMI) >25 kg/m², were referred to PCIWM. Participants underwent a nutrition assessment, set goals, received medical nutrition therapy from RDNs, integrated within their care plans, and were offered monthly RDN sessions. Data were sourced from electronic health records, PCIWM encounters, and survey responses. Descriptive statistics were used to examine baseline patient characteristics, initial service utilization from PCIWM, and survey responses.

Results: Participants' mean age was 46.8 years, a majority were female (85.3%) identified as White (65.5%), mean baseline weight was 115.0 kg, and mean baseline BMI was 41.82 (SD = 11.4, [22.25, 78.85]) (N = 61). 29% were actively engaged and had a mean of 3.4 RDN visits (mean duration = 100.7 min). The majority of survey respondents (N = 11, 63.6%) reported adhering to their goals. Additionally, 51.9% (n = 14 of 27) of participants who attended their scheduled appointments and had updated weights maintained (within 1 kg) or lost weight at time of follow-up. Patients' demonstrated mean BMI reductions of 2.7%.

Conclusions: PCIWM provides a unique model for virtual weight management, and pilot data suggest PCIWM is a feasible approach. Still, further research and advocacy efforts are needed for supportive policy and program expansion to manage patient's weight, cardiovascular risk, and other related health outcomes.