Rural Engagement in TelemedTeam for Options in Obesity Treatment Solutions (RE-TOOL)

项目概要/摘要 肥胖增加了13种癌症的风险，现在影响了超过40%的美国成年人，甚至有40%的人患有肥胖症。 在美国农村的患病率更高。最令人担忧的是，3级肥胖（BMI ≥ 40）的患病率， 癌症风险最高的癌症，在农村社区的增长率是农村社区的3倍， 到城市地区。农村居民经常缺乏体重控制计划、食物和体育活动 促进健康生活方式的资源，特别是在小的或偏远的农村地区。最重要的是肥胖症 在农村初级保健中提供治疗，特别是为那些患有3级肥胖症和/或合并症的人提供治疗。 病态的医疗条件谁携带肥胖相关的癌症风险最高。医疗管理A 初级保健提供者（PCP）在行为减肥是必不可少的，以解决共病医疗 条件，评估致肥胖药物，并探索指南推荐的选择 药物治疗和手术治疗。然而，在初级保健方面错过了一个机会- 基于指南的医疗管理的肥胖治疗试验。目前的审判建立在 我们最近在农村初级保健诊所完成了RE-POWER试验， 与个体访视相比，门诊组访视的体重减轻显著更大，并强调 当地PCP进行医疗管理的必要性。RE-TOOL（远程教育农村参与小组， 肥胖治疗方案的选择）是一项随机对照试验（n = 16家诊所和560名受试者），旨在 加强农村社区可持续获得肥胖症治疗的机会。TelemedTeam是一个新颖的基于团队的 远程医疗方法，将密集的远程医疗小组访问与每季度一次的个人小组诊所结合起来 同时让患者、当地PCP和生活方式教练参与的访视，以帮助激活患者。 这种新颖的协作远程医疗解决方案结合了基于小组的治疗和家庭治疗的优势， 基于远程医疗服务，关键是，在当地农村诊所整合基于团队的护理， 医疗管理和获得当地支持和资源的重要性。主要假设是， 与增强型产后护理相比，TelemedTeam在24个月时的体重减轻百分比更大 仅包括每季度一次的PCP访视。次要结局包括达到≥5%和10%的比例 体重减轻、饮食质量、身体活动、生活质量和医疗过程结果。探索性 分析将评估覆盖范围、采用情况和实施情况，并调查农村的社会文化和空间 治疗效果的预测因素。

PROJECT SUMMARY/ABSTRACT Obesity increases risk for 13 types of cancer and now affects over 40% of the U.S. adult population, with even higher prevalence among rural Americans. Most worrisome, the prevalence of class 3 obesity (BMI ≥ 40), which contributes the highest cancer risk, is increasing at a rate 3 times higher in rural communities compared to urban areas. Rural residents often lack access to weight control programs and food and physical activity resources that promote healthy lifestyles, especially in small or remote rural areas. It is paramount that obesity treatment be offered in rural primary care, especially to reach those who have Class 3 obesity and/or co- morbid medical conditions who carry the highest obesity-related cancer risk. Medical management by a primary care provider (PCP) during behavioral weight loss is essential to address co-morbid medical conditions, evaluate obesogenic medications, and explore options for guideline-recommended pharmacotherapy and surgical treatment. However, there has been a missed opportunity in primary care- based obesity treatment trials for capitalizing on guideline-based medical management. The current trial builds on lessons learned in our recently completed RE-POWER trial conducted in rural primary care clinics, which demonstrated significantly greater weight loss with in-clinic group visits versus individual visits, and highlighted the need for medical management by the local PCPs. RE-TOOL (Rural Engagement in TelemedTeam for Options in Obesity Treatment SoLutions) is a cluster RCT (n = 16 clinics and 560 participants) designed to enhance sustainable access to obesity treatment in rural communities. TelemedTeam is a novel team-based telemedicine approach that pairs intensive telemedicine group visits with quarterly individual team-based clinic visits that simultaneously engage the patient, the local PCP, and the lifestyle coach to help activate the patient. This novel collaborative telemedicine solution combines the benefits of group-based treatment with home- based telemedicine delivery, and critically, integrates team-based care in local rural clinics to capitalize on the importance of medical management and access to local support and resources. The primary hypothesis is that TelemedTeam will result in greater % weight loss at 24 months compared to Enhanced Usual Care consisting of quarterly PCP visits only. Secondary outcomes include the proportion achieving ≥5% and 10% weight loss, diet quality, physical activity, quality of life, and medical treatment process outcomes. Exploratory analyses will assess reach, adoption, and implementation and investigate rural sociocultural and spatial predictors of treatment effects.