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Primary Care Obesity Management in the Southeast_PROMISE

东南部的初级保健肥胖管理_PROMISE

基本信息

批准号：
9247183
负责人：
Gareth R Dutton
金额：
$ 60.63万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-01 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9247183
关键词：
Address Adoption Adult Affect Behavior Therapy Behavioral Body Weight Body Weight Changes Body Weight decreased Child Care Chronic Clinical Clinical Treatment Communities Cost Effectiveness Analysis Data Diabetes Mellitus Diabetes prevention Effectiveness Family Goals Health Care Costs Health Personnel Health system Healthcare Individual Intervention Investigation Managed Care Medical Care Team Modeling Moods Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Patient-Focused Outcomes Patients Persons Physical Function Physical activity Physicians Pilot Projects Prevention Primary Care Physician Primary Health Care Provider Public Health Quality of life Randomized Randomized Controlled Trials Recommendation Research Risk Schools Self-Direction Social Functioning Societies Strategic Planning Telephone Testing Training Translating Translational Research United States National Institutes of Health Visit Weight Weight maintenance regimen Work alternative treatment base clinically significant community center community setting compare effectiveness cost effective cost effectiveness cost-effectiveness evaluation diabetes management evidence base health care service utilization improved innovation lifestyle intervention member novel obesity management obesity prevention obesity treatment patient oriented peer peer coaching primary outcome programs psychosocial public health relevance research to practice response satisfaction screening secondary outcome standard care success treatment effect trial comparing weight loss intervention

项目摘要

DESCRIPTION (provided by applicant): Primary care offers a familiar and accessible clinical venue for patients affected by obesity to receive evidence- based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous interventions delivered by primary care physicians or other members of the healthcare team have often demonstrated modest and temporary weight loss for patients. Weight loss treatment delivered by trained peer coaches may offer a viable and effective alternative to address weight management in primary care. While peer coaches have successfully delivered behavioral interventions for other chronic conditions (e.g., type 2 diabetes) as well as obesity interventions in non-clinical settings (e.g., community centers), research is lacking on the effectiveness of translating peer- delivered weight loss interventions to primary care. Our preliminary work suggests that a weight loss intervention delivered in primary care by peer coaches can achieve clinically significant reductions in weight, is feasible for adoption in primary care, and is well-received by patients. In this application, we propose to conduct an 18-month randomized controlled trial comparing the effects of obesity treatment that includes either: 1) in-person and telephone-based contacts with peer coaches (peer coach treatment), or 2) routine contact with a primary care provider plus self-directed intervention materials (standard care). This weight loss trial will include 375 obese adults randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost- effectiveness of the peer coach intervention will also be evaluated. This is a novel investigation of the effectiveness and sustainability of an innovative alternative for obesity treatment delivery in primary care. If the peer coach intervention proves effective, it would have significant clinical and public health implications for patients, clinicians, and health systems. These potential benefits include: 1) improvement of clinical and psychosocial outcomes for patients, 2) increased treatment options for primary care providers to manage the care of obese patients, and 3) reduced healthcare utilization and costs.

描述（由申请人提供）：初级保健为肥胖患者提供了一个熟悉且方便的临床场所，以接受基于证据的生活方式干预措施来控制体重。然而，在初级保健中实施此类计划存在许多障碍，并且初级保健医生或医疗团队其他成员以前提供的干预措施往往表明患者的体重适度且暂时减轻。由训练有素的同伴教练提供的减肥治疗可能为解决初级保健中的体重管理问题提供可行且有效的替代方案。虽然同伴教练已成功地针对其他慢性病（例如 2 型糖尿病）以及非临床环境（例如社区中心）的肥胖干预提供了行为干预措施，但将同伴提供的减肥干预措施转化为初级保健的有效性仍缺乏研究。我们的初步工作表明，由同伴教练在初级保健中提供的减肥干预措施可以实现临床上显着的体重减轻，在初级保健中采用是可行的，并且受到患者的好评。在本申请中，我们建议进行一项为期 18 个月的随机对照试验，比较肥胖治疗的效果，其中包括：1）与同伴教练面对面和电话接触（同伴教练治疗），或 2）与初级保健提供者的常规接触加上自我指导的干预材料（标准护理）。这项减肥试验将包括从 10 个初级保健机构随机抽取的 375 名肥胖成年人。主要结果是第 18 个月时的体重变化。次要结果将包括以患者为中心的关键结果，包括生活质量、身体和社会功能、情绪和治疗满意度。还将评估同伴教练干预的成本效益。这是一项针对初级保健中肥胖治疗创新替代方案的有效性和可持续性的新颖调查。如果同伴教练干预被证明是有效的，它将对患者、临床医生和卫生系统产生重大的临床和公共卫生影响。这些潜在的好处包括：1）改善患者的临床和心理社会结果，2）增加初级保健提供者管理肥胖患者护理的治疗选择，以及3）减少医疗保健利用率和成本。