Impact of Integrating an Internet Weight Control Program into Primary Care

描述（由申请人提供）：每年，超重和肥胖患者与初级保健提供者（PCP）进行的7.5亿次访问中约有700次没有任何体重咨询。其主要原因是，PCP在帮助患者减肥方面的培训不足，并且在初级保健环境中没有持续有效的干预措施。虽然在人和电话为基础的体重控制程序一直难以传播的初级保健，在线体重控制程序越来越有效，并可能会被用于这些设置。鉴于越来越多的有效的在线程序，肥胖和其他条件看到在初级保健（例如，抑郁症、失眠症），重要的是要了解这些方案在纳入初级保健时是否有效，以及它们是否因提供者的参与而得到加强。对5A初级保健行为改变模型的研究表明，初级保健干预措施中最有效但使用最少的特征是安排随访，提供者要求患者对坚持治疗和实现特定结果负责。我们已经创建了一个简单的方法，将互联网体重控制计划整合到初级保健环境中，允许PCP监控患者的依从性和结果，并通过电子邮件向他们发送预先编写的，量身定制的后续消息。在我们的试点工作中，PCP认为这将有助于克服帮助患者减肥的关键障碍。在这项研究中，我们建议通过招募27名PCP和540名患者，并将他们随机分配到以下三种情况之一来测试将有效的自动化互联网体重控制计划整合到初级保健中的影响：A）简短的医生咨询+家庭护理，B）简短的医生咨询+转介和访问互联网体重控制计划和C）简短的医生咨询+转介和访问互联网体重控制计划+简短的后续电子邮件说明的支持和责任从PCP。我们假设12个月后，条件C v. B [5.0 kg（SD = 6.0）v. 3.0 kg（SD = 4.0）]和条件B v. A [3.0 kg（SD = 4.0）v. 1.0 kg（SD = 3.0）]的平均体重减轻更大，并且体重减轻与责任、登录、饮食和体力活动行为的变化相关。确定方法，如建议，利用医患关系，以改善患者的依从性和在线计划的结果可能会产生重大的公共卫生影响。

DESCRIPTION (provided by applicant): Every year, roughly 700 of the 750 million visits that overweight and obese patients make with primary care providers (PCPs) occur without any weight counseling. The main reasons for this are that PCPs are poorly trained to help their patients lose weight and that there are no consistently effective interventions for primary care settings. Though in-person and telephone- based weight control programs have been difficult to disseminate in primary care, online weight control programs are increasingly effective and may lend themselves to be used in these settings. Given the growing number of effective online programs, for obesity and for other conditions seen in primary care (e.g., depression, insomnia) it is important to understand whether these programs can be effective when integrated into primary care and whether they are enhanced by provider involvement. Research on the 5 A's model of primary care behavior change suggests that the most effective, yet least used feature of primary care interventions is arranging follow-up, where providers hold patients accountable to adhering to treatments and achieving specific outcomes. We have created a simple method for integrating an Internet weight control program into primary care settings, by allowing PCPs to monitor their patients' adherence and outcomes and email them pre-written, tailored follow-up messages. PCPs in our pilot work believed that this would help to overcome key barriers to helping their patients lose weight. In this study, we propose to test the impact of integrating an effective automated Internet weight control program into primary care, by recruiting 27 PCPs and 540 of their patients and randomizing them to one of three conditions: A) Brief physician counseling + Usual care, B) Brief physician counseling + Referral and access to a the Internet weight control program and C) Brief physician counseling + Referral and access to the Internet weight control program + brief follow-up email notes of support and accountability from PCPs. We hypothesize that mean weight losses after 12 months will be greater in Condition C v B [5.0kg (SD = 6.0) v. 3.0kg (SD = 4.0)] and in Condition B v. A [3.0kg (SD = 4.0) v. 1.0 kg (SD = 3.0)] and that weight loss will be associated with changes in accountability, logins, eating and physical activity behaviors. Identifying ways, such as proposed, to leverage the doctor-patient relationship to improve patient adherence and outcomes from online programs could have a significant public health impact.