No-show Appointments Research Articles

Interdisciplinary versus multidisciplinary treatment of obesity

Our goal was to determine if an interdisciplinary clinic was more effective than a multidisciplinary clinic in the treatment of obesity. We compared the retention rates, number of clinic visits, cancellations, no-show appointments, and dietary compliance between two types of nutrition-oriented clinics. The multidisciplinary group of patients was referred to dietetics from physicians through a traditional hospital outpatient program: the Nutrition Counseling Service (NCS). The interdisciplinary group of patients was in the Nutrition Medicine Clinic (NMC), where coordinated dietitian/physician services are provided. A total of 116 patients with medically significant obesity were selected: 65 from NCS and 51 from the NMC. Patients were considered “active” if they had two or more visits in the time period between September 1992 and February 1993, and if they had been seen within the last six weeks of the study period. We first compared age, sex, body mass index (BMI) and the number of comorbidities and their effect on retention. We then compared the total number of patient visits, cancellations and no-shows in each clinic, as well as compliance (measured by average weight lost and the percentage of patients who kept food records). Results indicate that the NMC had a better retention rate than NCS (53% vs. 42%). Women had a better retention rate (53%) than men (32%) in both clinics. Age, BMI and number of comorbidities were not associated with retention rate in either clinic. NMC patients had 50% more visits than NCS patients during the study period. There was no difference in the number of cancellations and no-shows between the two clinics. A large percentage of NMC patients kept food records (52% vs. 34%) and NMC patients lost more weight, on average, than NCS patients (7.2 vs. 2.5 lbs.). We suggest that the higher retention rate, the increased number of patient visits, and the increased compliance among NMC patients may be attributed to the interdisciplinary approach used in this clinic vs. the multidisciplinary approach used in the NCS. The benefits of the NMC include: physician reinforcement, concomitant presentation of expectations by the dietitian and physician, special medical services, team approach of all disciplines, and frequent telephone correspondence with patients. An interdisciplinary approach, as exemplified by the NMC, may be more beneficial than a traditional multidisciplinary approach in the treatment of certain patient populations with medically significant obesity (i.e. those requiring additional reinforcement or specialized medical services).