چکیده (انگلیسی):

Background:Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration
(VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients
ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC)
called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct
obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve
delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1)
current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with
the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting.
Methods:We recruited 25 PACT teamlet members from a single VA study site—11 PC physicians, 5 registered
nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)—for individual
interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally
transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis
in order to discover how the participants perceived and provided weight management care and what specific
attitudes affected their practices, all as bounded within the organization.
Results:Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling
and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by
training, whereas personal experience with their own weight management impacted role perception among LPNs/
RNs. Attitudes about whether or not they could impact patients’ weight outcomes via counseling or referral to MOVE!
varied. System-level communication about VHA priorities through electronic health records and time allocation
influenced teams to prioritize referral to MOVE! over weight management counseling.
Conclusion:We found a diversity of attitudes, and practices within PACT, and identified factors that can enhance
the MOVE! program and inform interventions to improve weight management within primary care. Although
findings are site-specific, many are supported in the literature and applicable to other VA and non-VA sites with
PCMH models of care.