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

项目摘要/摘要 肥胖增加了13种癌症的风险，现在影响着超过40%的美国成年人口，甚至 在美国农村地区的患病率更高。最令人担忧的是，3级肥胖症的流行(体重指数≥40)， 与农村社区相比，癌症风险最高的农村地区正以3倍的速度增长 到城市地区。农村居民往往无法获得体重控制计划以及食物和体育活动 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。肥胖是最重要的 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/或合并肥胖的人提供治疗。 与肥胖相关的癌症风险最高的病态医疗条件。医疗管理由一名 初级保健提供者(PCP)在行为减肥期间是解决共病医疗的关键 条件，评估肥胖药物，并探索指南推荐的选项 药物治疗和外科治疗。然而，在初级保健方面错过了一个机会- 以肥胖治疗试验为基础，以指导方针为基础的医疗管理。目前的试验建立在 关于我们最近完成的在农村初级保健诊所进行的RE-POWER试验的经验教训，该试验 与个人就诊相比，门诊集体就诊显示出明显更好的减肥效果，并强调 需要由当地的初级保健医生进行医疗管理。重新工具(远程团队中的农村参与) 肥胖治疗解决方案的选项)是一个集群RCT(n=16个诊所和560名参与者)，旨在 加强农村社区可持续获得肥胖治疗的机会。TelemedTeam是一种新的基于团队的 远程医疗方法，将密集的远程医疗小组访问与基于团队的季度诊所配对 同时让患者、当地初级保健医生和生活方式教练参与的探访，以帮助激活患者。 这一新的协作式远程医疗解决方案将基于组的治疗的好处与家庭- 基于远程医疗的提供，关键是整合了当地乡村诊所的基于团队的护理，以利用 医疗管理以及获得当地支持和资源的重要性。主要的假设是 与增强的常规护理相比，TelemedTeam将在24个月内实现更大的体重减轻百分比 仅包括每季度一次的PCP访问。次要结果包括达到≥5%和10%的比例 体重减轻、饮食质量、体力活动、生活质量和医疗过程结果。探索性的 分析将评估覆盖范围、采用和实施，并调查农村社会文化和空间 治疗效果的预测指标。

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.