JMIR Publications

ABSTRACT

Background:

Obesity is a pressing health concern nationwide – particularly in small rural communities.

Objective:

The purpose of this study was to examine the utility of different physician referral and engagement processes for improving reach of an evidence-based and technology-delivered weight management program with counseling support.

Methods:

Five rural primary-care physicians were randomly assigned a sequence of four referral strategies: point of care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry-derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with a BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail.

Results:

A total of 573 of a potential 991 referrals were made over 16 weeks and 98 patients enrolled in the program (60% female). Of the 991 potential referrals, differences based on letter (n=485) versus POC (n=506) referrals, respectively, were identified for completion (100% vs 7%; p<.001) and proportion screened (36% vs 12%; p<.01), but not for proportion enrolled (12% vs 8%; p=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; p<.001) and enrolled (15% vs 7%; p<.001) when compared to those without ATF. Based on the number of referrals made in each condition, we found variations in proportion and number of enrollees (POC with ATF, 50%, n=27; POC no ATF, 41%, n=14; letter ATF 15%, n=30; letter no ATF 9%, n=27). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female (p=.15); 94% Caucasian (p=.60); 94% Non-Hispanic (p=.19). Recruitment costs totaled $6,192 and overall recruitment cost per enrolled participant was $63. Cost per enrolled participant ranged from POC with ATF ($47), registry-derived letter without ATF ($52), POC without ATF ($56), to registry-derived letter with ATF ($91).

Conclusions:

Letter referral with ATF appears to be the best option for enrolling a large number of patients in a weight-management program, but resource costs in the large volume of telephone calls may make other options more attractive and dependent on the best fit with clinical resources. Clinical Trial: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT03690557), Registered 10 October, 2018; https://clinicaltrials.gov/ct2/show/NCT03690557?term=NCT03690557&draw=2&rank=1