Prevention and Management of Overweight and Obesity in Children and Adolescents
- Implementation Tools and Considerations
To improve healthcare provision, quality, safety, and patient outcome, evidence-based recommendations must not only be developed, but also disseminated and implemented at national and local levels and integrated into clinical practice.
Dissemination involves educating related healthcare providers to improve their awareness, knowledge and understanding of the guideline’s recommendations. It is one part of implementation, which involved translation of evidence-based guidelines into real life practice with improvement of health outcomes for the patients.
Implementation requires an evidence-based strategy involving professional groups and stakeholders and should consider the local cultural and socioeconomic conditions. Cost-effectiveness of implementation programs should be assessed.
Specific steps need to be followed before clinical practice recommendations can be integrated into local clinical practice, particularly in low resource settings.
Steps of implementing prevention and management of overweight and obesity in children and adolescents strategies into the Egyptian health system:
1. Develop a multidisciplinary working group.
2. Assess the status of nutritional care delivery, care gaps and current needs.
3. Select the material to be implemented, agree on the main goals, identify the key recommendations for diagnosis, treatment and prevention and adapt them to the local context or environment.
4. Identify barriers to, and facilitators of implementation.
5. Select an implementation framework and its component strategies.
6. Develop a step-by-step implementation plan:
· Select the target populations and evaluate the outcome.
· Identify the local resources to support the implementation.
· Set timelines.
· Distribute the tasks to the members.
· Evaluate the outcomes.
7. Continuously review the progress and results to determine if the strategy requires modification.
Guideline implementation strategies will focus on the following: -
1. For Practitioners
· Educational meetings: conferences, lectures, workshops, grand rounds, seminars, and symposia.
· Educational materials: printed or electronic information (software).
· Web-based education: computer-based educational activities.
· A trained person meets with providers in their practice setting to provide information with the intention of changing the provider’s practice. The information may include feedback on the performance of the provider(s).
· Reminders: the provision of information verbally, on papers or on a computer screen to prompt a health professional to recall information or to perform or avoid a particular action related to patient care.
· Optimize professional-patient interactions, through mass media campaigns, reminders, and education materials.
· Practice tools: tools designed to facilitate behavioral/practice changes, e.g., flow charts.
2. For Patients and care givers
· Patient education materials (Arabic booklet): Printed/electronic information aimed at the patient/consumer, family, caregivers, etc.
· Reminders: the provision of information verbally, on papers or electronically to remind a patient/consumer to perform a particular health-related behaviors.
· Mass media campaigns.
3. For Nurses
· Educational meetings: lectures, workshops or traineeships, seminars, and symposia.
· Educational materials: printed.
· A trained person meets with nurses in their practice setting to provide information with the intention of changing the provider’s practice.
· Reminders: the provision of information verbally, on paper or on a computer screen to prompt them to recall information or to perform or avoid a particular action related to patient care.
· Practice tools: tools designed to facilitate behavioral/practice changes.
4. For Stakeholders
Plans have been made to contact with all the health sectors in Egypt including all sectors of the Ministry of Health and Population, National Nutrition Institute, University Hospitals, Ministry of Interior, Ministry of Defense, Non-Governmental Organizations, Private sector, and all Health Care Facilities.
· Information and communication technology: Electronic decision support, order sets, care maps, electronic health records, office-based personal digital assistants, etc.
· Any summary of clinical provision of health care over a specified period may include recommendations for clinical action. The information is obtained from medical records, databases, or observations by patients. Summary may be targeted at the individual practitioner or the organization.
· Administrative policies and procedures.
· Formularies: Drug safety programs, electronic medication administration records.
5.Other activities to assist the implementation of the adapted guideline’s recommendations include:
· International initiative: Dissemination of the presented adapted CPG internationally via sending the final adapted CPG to the Guidelines International Network (GIN) Adaptation Working Group and contacting the CPG developers.
· Gantt chart has been designed to manage the dissemination and implementation stages for the adapted CPG over an accurate time frame (Appendix).
Evidence to Decision Tables: (if any)
Guideline Implementation Tools
Educational materials based on this Adapted CPG for prevention and management of overweight and obesity in children and adolescents have been made available in several forms including:
• Educational materials based on this Adapted CPG are made available in several forms, including
- Booklet with executive summary of guidelines for physicians and primary health care professionals.
Limitations and suggestions for further research needs
Future research recommendations for prevention and management of overweight and obesity in children and adolescents in the Egyptian context could include:
· Epidemiological studies on prevalence of overweight and obesity.
· Further studies on pharmacological & surgical rôle in obesity in children and adolescents.
These recommendations aim to address specific challenges and characteristics of the Egyptian context, potentially leading to more effective prevention and management strategies for overweight and obesity in children and adolescents.
Challenges
· Media promotion for Junk food.
· Pharmacological options limitation of use in pediatrics & limited resources for evidence.
Strengthen the evidence base of the next update of this guideline by generating GRADE summary of finding tables, evidence profiles, and EtD frameworks.
Monitoring and evaluating the impact of the guideline.
The following are three performance measures or indicators for implementing this adapted CPG for prevention and management of overweight and obesity in children and adolescents:
1. Adherence to prevention and management of overweight and obesity in children and adolescent Guidelines
· Numerator: Number of children with overweight and obesity who received treatment as per guideline recommendations.
· Denominator: Total number of children diagnosed with overweight and obesity.
· Data Source: Hospital or clinic patient records.
2. Duration of Hospital Stay
· Numerator: Total number of hospital stay days for children with overweight and obesity.
· Denominator: Total number of children admitted with overweight and obesity.
· Data Source: Hospital admission and discharge records.
3. Rate of Readmission
· Numerator: Number of children readmitted with symptoms of overweight and obesity within a certain period (e.g., 30 days) after discharge.
· Denominator: Total number of children initially admitted with overweight and obesity.
· Data Source: Hospital readmission records.
These key performance indicators are designed to measure the effectiveness and adherence to the guidelines, the efficiency of the treatment in terms of resource utilization (hospital stay), and the success of the treatment in preventing further complications (readmissions).
Updating of the guideline
The EPG prevention and management of overweight and obesity in children and adolescents GAG has decided to conduct the next review of this adapted CPG for updates after five years. This should be carried out in 2029 after checking for updates in the source CPGs, consultation of expert opinion on the changes needed for updating according to the newest evidence and recommendations published in this area and the clinical audit and feedback from implementation efforts in the aforementioned local healthcare settings except if any breakthrough evidence- based recommendations are published before that date. The process will be guided by the Checklist for the Reporting of Updated Guidelines (CheckUp) Tool that is freely provided by the AGREE Enterprise and by the Reporting Items for Practice Guidelines in Healthcare (RIGHT) extension for adapted guidelines RIGHT-Ad@pt Checklist.