Implementing a Lifestyle Medicine Program via Telehealth to Optimize GERD Management in WTC First Responders

项目摘要/摘要： 胃食管反流病 (GERD) 是世界贸易中心 (WTC) 认证的第二常见慢性病 病情，发病机制与世贸中心粉尘和烟雾暴露以及食道刺激有关 内膜导致长期炎症。由于 GERD 的临床患病率，WTC 相关疾病 对于 GERD、药物副作用和费用的风险，考虑生活方式医学 (LM) 至关重要 优化经认证患者的 GERD 管理。此外，世贸中心急救人员越来越多地表示 担心长期使用某些胃食管反流病药物可能产生的副作用。 GERD，类似于 绝大多数慢性病可以通过采取最大限度地营养的生活方式措施来控制， 体力活动、睡眠和其他健康习惯。证据表明临床医生的力量是强大的 激励因素帮助患者做出行为改变，从而预防、治疗甚至逆转慢性病 条件。 LM 通过为临床医生提供强调他们作为“健康教练”角色的工具来正式化这些努力 确定并支持患者改变生活方式的准备和信心，以便他们能够 成功养成持久的健康习惯。由训练有素的临床医生提供的 LM 技术已被证明 帮助患者做出重大且持久的行为改变，从而改善临床结果。作为一个 由于 COVID-19 大流行，远程医疗已成功融入西奈山世贸中心健康中心 计划临床卓越中心 (WTCHP CCE) 已成为一种重要且流行的方式 患者接受护理。整合通过现有远程医疗服务提供的 LM 计划将增加 患者接触的机会——促进行为改变以改善 GERD 的关键因素。 教育患者成功坚持 LM 一线疗法需要技能和时间，而不是机会 大多数世贸中心提供商均可使用。 R21 的目的是评估一项计划的有效性和可行性 针对经认证的 GERD 的响应者开展 LM 计划，以减轻症状和/或对药物的需求。这个项目 新颖之处在于：1）它基于美国学院建议的循证LM干预 生活方式医学；包括健康习惯评估、目标确定、改变的准备/信心、 并同意行动计划以及为期 6 个月的每月随访 2) 将由经过 LM 培训的临床医生实施 3) 并将通过一个虚拟护理平台进行，该平台结合了健康跟踪技术以及参与的能力 并长期支持患者。计划评估将包括评估 参与者注册和保留、可行性和参与者对干预的满意度以及有效性 减轻胃食管反流病症状、药物使用并帮助参与者实现健康目标。

Project Summary/Abstract: Gastroesophageal reflux disease (GERD) is the 2nd most common World Trade Center (WTC) certified chronic condition, with pathogenesis connected to WTC dust and fumes exposure and irritation of the esophageal lining leading to prolonged inflammation. Due to the clinical prevalence of GERD, WTC conditions associated with GERD, risk of medication side effects and costs, it is critical to consider Lifestyle Medicine (LM) to optimize management of GERD in certified patients. In addition, WTC first responders have increasingly voiced concerns about possible side-effects related to chronic use of some GERD medications. GERD, similar to the vast majority of chronic conditions, can be managed by adopting lifestyle measures that maximize nutrition, physical activity, sleep, and other healthy habits. Evidence demonstrates that clinicians can be powerful motivators to help patients make behavioral changes that can prevent, treat and even reverse chronic conditions. LM formalizes these efforts by giving clinicians tools that emphasize their role as “health coaches” to identify and support patient readiness and confidence in making lifestyle changes so that they can successfully adopt long-lasting healthy habits. LM techniques, delivered by trained clinicians, have been shown to help patients make significant and long-lasting behavioral change that improves clinical outcomes. As a result of the COVID-19 pandemic, telehealth was successfully integrated into the Mount Sinai WTC Health Program Clinical Center of Excellence (WTCHP CCE) and has become an essential and popular way for patients to receive care. Integrating a LM Program delivered via existing telehealth services would increase opportunity for patient encounters—a crucial factor in facilitating behavior changes that can improve GERD. Educating patients to successfully adhere to LM first-line therapies requires skills and time-opportunity not available to most WTC providers. The objective of this R21 is to evaluate the effectiveness and feasibility of a LM program in responders with certified GERD, to reduce symptoms and/or need for medications. This project will be novel in that: 1) it is based on the evidence-based LM intervention as advised by the American College of Lifestyle Medicine; including health habit assessments, goal identification, readiness/confidence to change, and agreeing to action plans with monthly follow-up for 6 months 2) will be delivered by LM-trained clinicians 3) and will occur via a virtual care platform that incorporates health tracking technology, and the ability to engage and support patients over an extended period of time. Program evaluation will consist of assessment of participant enrollment and retention, feasibility and participant satisfaction with intervention, and effectiveness in lowering GERD symptoms, medication use and helping participants reach their health goals.