Posted: February 15th, 2022
For adult patients with a BMI > 30, does the implementation of the American Heart Association Dietary and Physical Activity Guidelines, compared to current practice, impact participants’ weight and waist circumference over 8-10 weeks?
Simulated Project Implementation for Weeks 1–10
The study is a quality improvement project seeking to help obese patients reduce weight and manage the disease burdens associated with overweight complications. The study targets obese patients in Miami; therefore, the project will be conducted in an outpatient diabetes mellitus and hypertension clinic for patients with obesity.
Activities are spread out in the ten weeks of the project. The plan is to obtain a signed consent form from all the participants. In the first week, all the participants will meet with a dietician and physiologist at the clinic. During this initial meeting, baseline measurements for all the participants’ weight, BMI, and waist circumference will be recorded. Each participant will also be provided with the American Heart Association Dietary and Physical Activity Guidelines and logbooks. The participants will use the logbooks to record their daily food intake, exercise, and weight measured each morning.
At the end of each week, the participants will be contacted through phone calls to review their progress in filling in the logbooks and answer any questions. Weekly check inns will encourage the participants to adhere to the AHA guidelines and data recording. There is a compliance checklist to document calls for uniformity since one person will not make all calls. Each week, all the participants will receive a text of encouragement.
The participants will visit the clinic for weight, BMI, and waist circumference measurements by the interdisciplinary team. After data collection from this week, a statistician will be engaged to assist with data analysis.
How The COVID-19 Pandemic Affected Organizational Operations and the Development of The Project?
The Covid -19 Pandemic changed how organizations operate to observe the social distancing requirement. Patients received their scheduled consultations with their doctors through video or phone calls in most clinics. Patients called their pharmacists to refill their prescriptions then have them delivered. Hospitals made an effort to avoid having any unnecessary people unless recommended by the physician. It affected the project because it made it more difficult to recruit participants. The project relied on physicians informing patients at the clinic about the project and convincing them how it could be beneficial for them. The limited interaction between the physicians and patients did not provide ample time to recruit. The physicians felt patients would feel bombarded when they were worried about the pandemic. They also expressed that the patients kept the interaction at a minimum, and sometimes the service was so bad they could not communicate well. On average, it required three phone or virtual conversations to recruit participants. Delays in participant recruitment, in turn, delayed project implementation.
Barriers and Challenges
There have been challenges from the clinic, participants and the interdisciplinary team intended for the project. The clinic can no longer allow a group of people to meet at their premises. This means that if I cannot get another location big enough to accommodate the participants, I will have to do the initial meeting virtually. This one comes with another set of challenges. The participants might not adhere to the time set for their one on one virtual meeting with the dietician and physiologists. Some do not have access to the right internet speeds to support a virtual meeting. To overcome this challenge I have been forced to recruit so many participants and make inquiries about access to a smart phones and WIFI during recruitment. Having enough participants who fill out at least 80% of their daily details will help reduce attrition bias (Catalogue of Bias, 2018). Participants who do not fill in their details during the last three weeks will not be considered. The project will make use of an interdisciplinary team to ensure the participants receive the right information and guidance on diet and work out. Most of the team members are willing to dedicate some hours once a week. The challenge is getting the patients to avail themselves during the specific times. Since there is nothing much I can do about this situation the team developed a list of compliance questions for the participants. I will need to do follow up for those participants who miss their scheduled time with the professionals and carry out the review using the questions.
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