Barriers to Counseling Patients With Obesity
Barriers to Counseling Patients With Obesity
Objective: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics associated with these barriers.
Design: Cross-sectional mail survey.
Setting: Texas.
Participants: 139 community pharmacists.
Intervention: Self-administered questionnaire.
Main Outcome Measures: Respondents' perceived barriers to pharmacists' counseling of obese patients.
Results: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations (55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes counseled obese patients and were somewhat comfortable with counseling about obesity management. They perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without medications were significantly more likely to view the various obesity management strategies as less effective, compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers.
Conclusion: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics and beliefs about obesity were significantly associated with their perceived barriers.
The combined prevalence of overweight (body mass index [BMI] 25-29.9 kg/m) and obesity (BMI ≥30 kg/m) was 64.5% in the United States in 1999-2000. Second only to smoking as a preventable risk factor for morbidity and mortality, an increased BMI has been identified as a key modifiable risk factor for many chronic diseases, including hypertension, dyslipidemia, and type 2 diabetes mellitus, as well as sleep apnea and gallbladder, vascular, and gastroesophageal reflux diseases. Previously attributed to a lack of willpower and considered as more of a cosmetic or lifestyle issue, overweight and obesity have been more recently defined as a chronic medical condition warranting a multifactorial approach, including drug therapy. Indeed, the Healthy People 2010 initiative identified overweight and obesity as one of the 10 leading health indicators to be addressed to improve the quantity and quality of life for Americans.
Given the multiple comorbidities typically present with obesity, these patients often interact with their community pharmacists to obtain prescriptions as well as over-the-counter (OTC) products for these conditions. Indeed, pharmacists are often identified as the uniquely accessible member of the health care team who can assist patients in health promotion, including attaining a more healthy weight. An earlier pilot study of physician counseling on obesity demonstrated that multiple brief (15-20 minutes) counseling sessions were as effective as referrals for more lengthy sessions.
Subsequently, in 2001, the American Society of Health-System Pharmacists (ASHP) put forth a position statement on the safe use of pharmacotherapy for adult obesity management. ASHP encouraged pharmacists to provide pharmaceutical care to their obese patients through reinforcement of lifestyle modifications, education, and encouragement.
Recent studies have indicated that community pharmacists' involvement is associated with successful weight loss. A 2003 study of eight community pharmacists, after 1 day of training, demonstrated enhanced therapy persistence and attainment of greater than 3% weight loss, compared with a control group that did not receive pharmacist support. Additionally, a recent randomized study of two weight reduction interventions showed that patients lost weight and their blood pressure and triglyceride concentrations improved when the pharmacist was the point of contact for dietary advice. However, despite the evidence that pharmacist counseling could be effective and that professional associations encourage pharmacists to be proactive, community pharmacists do not routinely counsel regarding obesity management.
Subsequent to OBRA '90, the Omnibus Budget Reconciliation Act of 1990, much research has focused on barriers to pharmacist counseling, and authors have proffered strategies to increase counseling frequency. While several papers identified physician barriers to counseling of obese patients, including negative preconceived notions about people with obesity, studies have not examined the potential barriers to pharmacists' counseling of this important patient group, one that continues to grow in numbers.
Abstract and Introduction
Abstract
Objective: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics associated with these barriers.
Design: Cross-sectional mail survey.
Setting: Texas.
Participants: 139 community pharmacists.
Intervention: Self-administered questionnaire.
Main Outcome Measures: Respondents' perceived barriers to pharmacists' counseling of obese patients.
Results: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations (55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes counseled obese patients and were somewhat comfortable with counseling about obesity management. They perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without medications were significantly more likely to view the various obesity management strategies as less effective, compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers.
Conclusion: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics and beliefs about obesity were significantly associated with their perceived barriers.
Introduction
The combined prevalence of overweight (body mass index [BMI] 25-29.9 kg/m) and obesity (BMI ≥30 kg/m) was 64.5% in the United States in 1999-2000. Second only to smoking as a preventable risk factor for morbidity and mortality, an increased BMI has been identified as a key modifiable risk factor for many chronic diseases, including hypertension, dyslipidemia, and type 2 diabetes mellitus, as well as sleep apnea and gallbladder, vascular, and gastroesophageal reflux diseases. Previously attributed to a lack of willpower and considered as more of a cosmetic or lifestyle issue, overweight and obesity have been more recently defined as a chronic medical condition warranting a multifactorial approach, including drug therapy. Indeed, the Healthy People 2010 initiative identified overweight and obesity as one of the 10 leading health indicators to be addressed to improve the quantity and quality of life for Americans.
Given the multiple comorbidities typically present with obesity, these patients often interact with their community pharmacists to obtain prescriptions as well as over-the-counter (OTC) products for these conditions. Indeed, pharmacists are often identified as the uniquely accessible member of the health care team who can assist patients in health promotion, including attaining a more healthy weight. An earlier pilot study of physician counseling on obesity demonstrated that multiple brief (15-20 minutes) counseling sessions were as effective as referrals for more lengthy sessions.
Subsequently, in 2001, the American Society of Health-System Pharmacists (ASHP) put forth a position statement on the safe use of pharmacotherapy for adult obesity management. ASHP encouraged pharmacists to provide pharmaceutical care to their obese patients through reinforcement of lifestyle modifications, education, and encouragement.
Recent studies have indicated that community pharmacists' involvement is associated with successful weight loss. A 2003 study of eight community pharmacists, after 1 day of training, demonstrated enhanced therapy persistence and attainment of greater than 3% weight loss, compared with a control group that did not receive pharmacist support. Additionally, a recent randomized study of two weight reduction interventions showed that patients lost weight and their blood pressure and triglyceride concentrations improved when the pharmacist was the point of contact for dietary advice. However, despite the evidence that pharmacist counseling could be effective and that professional associations encourage pharmacists to be proactive, community pharmacists do not routinely counsel regarding obesity management.
Subsequent to OBRA '90, the Omnibus Budget Reconciliation Act of 1990, much research has focused on barriers to pharmacist counseling, and authors have proffered strategies to increase counseling frequency. While several papers identified physician barriers to counseling of obese patients, including negative preconceived notions about people with obesity, studies have not examined the potential barriers to pharmacists' counseling of this important patient group, one that continues to grow in numbers.
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