- Jyotsna Ghosh: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Kimberly A Gudzune: American Board of Obesity Medicine Foundation, Denver, CO, USA.
- Jessica L Schwartz: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background: Electronic health record (EHR)-based tools, such as clinical decision support systems (CDSS), support practitioners to promote evidence-based care, which may include obesity treatment. Our objective was to identify obesity-focused CDSS for adult patients in primary care settings to describe their designs, associated primary care practitioner (PCP) training, and outcomes among PCPs and patients.
Methods: We conducted a scoping review to identify and map available evidence using a search strategy for citations in MEDLINE from February 2009 to June 2024. We extracted information from included studies that described EHR-based CDSS tools designed to support obesity care (e.g., clinical decision support, counseling) for adult patients in primary care settings. We mapped common tool features to support weight management and synthesized key lessons learned during implementation of these tools.
Results: Of the 445 citations identified in our search, we included 13 citations reporting on 8 studies. The most common features across EHR-based CDSS tools were 1) identifying overweight or obesity using BMI (88 %) and 2) suggesting treatment strategies (88 %), particularly lifestyle modifications. Most studies provided limited information on the training PCPs received. Few PCPs used the CDSS with eligible patients (<20 %), describing these tools as cumbersome and lacking clinical workflow integration. Novel approaches included using CDSS during weight management-dedicated visits or for referral to obesity medicine physicians, which both showed promising early results of patients achieving weight reduction.
Conclusion: There is a growing body of evidence for obesity-focused CDSS among adult patients in the primary care setting. Our review identified three key lessons that may inform future health system implementation: 1) EHR-based CDSS tools need to be easy to use and integrate with clinical workflows; 2) PCPs need training on these tools for obesity treatment; and 3) Primary care workflow or work-scope may need to be modified to address obesity.