Physicians Extend Their Reach Beyond the Office

It looks like any other outdoor recreation program in America. Kids are playing in a Baltimore, MD park, running around and enjoying some fresh air. But this isn't the usual playground scenario. Hanging out with the kids are also physicians.

They're having fun, too—but with an eye toward preventing future chronic conditions or obesity in their charges, according to Bernadette Loftus, MD, associate executive director of Kaiser Permanente's Mid-Atlantic Medical Group.

Hundreds of doctors have devoted time within the past year to the Kaiser Permanente Docs in the Park program. It's an effort to help kids lose weight and get healthy, Loftus said during a HealthLeaders Media Rounds this month in Washington D.C. Kaiser Permanent wants to get the message across that physicians can influence healthy behavior outside the confines of their offices.

The physicians aren't just observers. They run around with the kids, too, and find "teachable moments" to talk about food and weight, Loftus says. "You can have some of those conversations in the park. It's a little more intimidating with an exam room. When you think about kids today, just getting them out to play is a challenge," Loftus says."

While fingers fly to text on cell phones or in video gaming, whole body movement suffers. And kids aren't the only slackers.

Adults are too sedentary, as well. Getting physicians outside their offices to engage in the community encourages their patients' behaviors toward better health, whether it's children or adults, says William H. Dietz, MD, PhD, former director of the division of nutrition, physical activity and obesity for the Centers for Disease Control and Prevention.

"We have not done a good job of equipping anyone in the health care field—physicians or nurses—with a set of tools to be available outside of the doctor's office," Ditz said during the Rounds event.

Kaiser Permanente officials want to change that dynamic. Docs In the Park is one of the ways that Kaiser Permanente's model for "total health" is attempting to bend back healthcare costs and keep the population healthy.

An integrated system, Kaiser has the nation's largest nonprofit health plan, runs 37 hospitals and serves 9 million members in nine states and the District of Columbia. KP includes 16,658 physicians.

"There's no way to tackle all these problems [diabetes, hypertension, obesity and inactivity] with one-to-one, doctors' face-to-face office visits," Loftus adds. "You reach people where they live and work and go to school. We ostensibly need to find partners that can help us access our population in a different way and a different place so we can get at behaviors most of us agree on."

Enlisting physician involvement "has not been a challenge, whatsoever," Loftus says. And the numbers prove it: After a call for physician volunteers to partner with schools, 130 doctors agreed to participate in a 10-day period, Loftus says. 

"This resonates with our doctors," she adds. They have organized games, "dodge ball; red light, green light. And we usually get a little bit of healthy eating there; we don't go to the ice cream stand. We say, ‘Here's some fruit.'"

Kaiser Permanente wants its patients to lose weight, exercise, and eat better. After all, it referenced studies that more than 33% of children and adolescents and about 65% of all adults are overweight or obese.

Despite its efforts, KP acknowledges that there are demographic, educational, and poverty issues within the communities it serves. Kaiser Permanente found it was important to coordinate programs with the community because, well, that's in fact where the people live, to open the possibility for recreational opportunities," Loftus says.

Kaiser Permanente's Mid-Atlantic States region includes a variety of programs to engage people and community around improving health. Nearly $40 million is directed to charitable care and coverage, including a medical care for children program that impacts 8,500 vulnerable residents.

Indeed, it is important for physicians to engage patients for preventative treatment, says Loftus. It's not only about being outside, on the turf, but it's about technology, too.

Using social media such as Twitter feeds, downloadable apps, and secure messaging, Kaiser Permanente officials say they are creating critical links to patients and their families that allow physicians to influence behaviors for better health.

In a program known as My Health Manager, physicians essentially make agreements with patients who vow to lose weight. The doctor and patient email each other, and the physicians build in reminder emails to patients who haven't met their weight goals. A flowchart is set up on a Kaiser Permanente website to track the information, according to Debra Carlton, MD, associate medical director of primary care, behavioral health, informatics, coding and documentation for the Southwest Permanente Medical Group.

"We want to transcend the office visit" Carlton says.

Physicians offer their personal bios online, and it's not the usual curriculum vitae. They write about their families, or even their personal issues, such as their own encounters with the health system as patients.

"Patients are feeling they can engage with this person, and that's how our clinicians are beginning to think, too," Carlton says.