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

通过远程医疗实施生活方式医学计划，以优化世贸中心急救人员的 GERD 管理

• 批准号: 10315283
• 负责人: JOHN D MEYER
• 金额: $ 24.83万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315283
• 关键词: Implementing; Lifestyle; Medicine; Program; via

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.

项目概要/摘要： 胃食管反流病（GERD）是世界贸易中心（WTC）认证的第二大常见慢性 疾病，发病机制与WTC粉尘和烟雾暴露和食管刺激有关 衬里导致长期炎症。由于GERD的临床患病率，WTC条件相关 对于GERD，药物副作用和成本的风险，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，世贸中心的第一反应者越来越多地表示， 担心与长期使用某些GERD药物相关的可能副作用。GERD，类似于 绝大多数慢性病，可以通过采取最大限度地增加营养的生活方式措施来管理， 身体活动，睡眠和其他健康的习惯。证据表明，临床医生可以是强大的 动机，以帮助患者作出行为改变，可以预防，治疗，甚至扭转慢性 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 确定并支持患者在改变生活方式方面的准备和信心，以便他们能够 成功地养成长期健康的习惯。LM技术，由训练有素的临床医生提供，已被证明 帮助患者做出显著且持久的行为改变，从而改善临床结果。作为 由于COVID-19大流行，远程医疗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），并已成为一个必不可少的和流行的方式， 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 这是促进行为改变的关键因素，可以改善GERD。 教育患者成功坚持LM一线治疗需要技能和时间-机会，而不是 提供给大多数WTC供应商。本R21的目的是评估 LM计划用于经认证的GERD应答者，以减少症状和/或药物需求。这个项目 将是新颖的，因为：1）它是基于证据为基础的LM干预建议，由美国学院 生活方式医学;包括健康习惯评估，目标识别，改变的准备/信心， 并同意每月随访6个月的行动计划2）将由LM培训的临床医生提供3） 并将通过一个虚拟护理平台，结合健康跟踪技术，并能够参与 并在很长一段时间内支持患者。项目评估将包括以下评估： 参与者招募和保留、可行性和参与者对干预的满意度以及有效性 降低GERD症状，药物使用和帮助参与者达到他们的健康目标。