Families Chose In-Person Visits over Telehealth for Pediatric Weight Management during the COVID-19 Pandemic.

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, telehealth was implemented as a method of care delivery in many pediatric weight management programs (PWMPs). To compare patient/family preference of telehealth vs. in-person visits, we analyzed patient visits during a period when families were given the option of scheduling in-person or telehealth visits for both new and follow-up visits during the pandemic. Methods: A retrospective review was done of our center's electronic medical record of patient visits from July 1, 2020 to December 31, 2020. Results: There were 1356 completed PWMP visits, with 977 (72.1%) done in-person and 379 (27.9%) done by telehealth. Telehealth was selected more often for follow-up visits (31.4%) compared with new visits (18.8%) [odds ratio (OR) = 2.052, p = 0.008]. Black patients (30.5%) selected telehealth more often than White patients (26.1%, OR = 1.371; p = 0.03). Conclusions: Although telehealth increases flexibility and increases options to families, in-person clinic visits seem to be preferred especially for an initial visit.

Effects of a Pediatric Weight Management Intervention on Parental Stress.

Background: Few studies have examined the associations of pediatric weight management interventions (PWMIs) with reduction in parental stress. We sought to examine the extent to which a PWMI reduces parental stress and whether changes in parental healthful feeding practices and support for physical activity are associated with reduction in parental stress. Methods: We analyzed data from the Clinic and Community Approaches to Healthy Weight randomized controlled trial (RCT). Parental stress change over 12 months was analyzed using a multivariate mixed linear model. We then examined associations of changes in healthful feeding practices and support for physical activity over 12 months with changes in stress using a multivariate linear model. Results: In multivariate-adjusted models, participation in a PWMI was associated with decrease in parental stress at 12 months, with a mean difference (MD) of -0.24 U [95% confidence interval (CI): -0.45, -0.04]. Increases in scores for exercising regularly [MD = -0.27 (95% CI: -0.52, -0.03)] and keeping healthy food at home [MD = -0.38 (95% CI: -0.66, -0.10)] were associated with decrease in stress. Conclusions: Participation in a PWMI was associated with decrease in parental stress. Encouraging parents of children with overweight and obesity to keep healthy food in the house and exercise regularly may represent important strategies to improve parental stress. PWMI effectiveness studies should consider parental stress as an outcome while addressing social determinants of health that may influence parental stress. Clinical Trial Registration Number: NCT03012126.

Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial.

BACKGROUND: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. OBJECTIVE: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). METHODS: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. RESULTS: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. CONCLUSIONS: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. TRIAL REGISTRATION: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.