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

农村参与远程医疗团队寻求肥胖治疗解决方案选择 (RE-TOOL)

基本信息

批准号：
10372530
负责人：
Christie Befort
金额：
$ 90.03万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-15 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10372530
关键词：
Address Adoption Adult Affect Area Behavior Behavioral Body Weight decreased Body mass index Cancer Etiology Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Clinic Clinic Visits Code Communities Commuting Consumption County Data Diet Energy Intake Environment Evaluation Evidence based treatment Fatty acid glycerol esters Food Geography Guidelines Health High Prevalence High-Risk Cancer Home Human Resources Improve Access Individual Intervention Kansas Knowledge Lead Life Style Maintenance Malignant Neoplasms Measures Medical Obesity Obesity associated cancer Office Visits Operative Surgical Procedures Outcome Participant Patients Pharmaceutical Preparations Pharmacotherapy Physical activity Plants Population Prevalence Primary Care Physician Primary Health Care Process Publishing Quality of life Reach Effectiveness Adoption Implementation and Maintenance Resources Risk Rural Rural Community Rural Population Telemedicine Telephone Testing Time Tobacco Transportation Visit Walking Weight Weight maintenance regimen arm bariatric surgery base built environment cancer risk cancer type care providers comorbidity design diabetes prevention program effectiveness evaluation experience healthy lifestyle implementation outcomes low socioeconomic status novel obesity treatment obesogenic patient-clinician communication prevent programs rural Americans rural area rural dwellers rural setting secondary outcome social culture social disadvantage sociodemographic factors support network treatment as usual treatment effect treatment trial uptake urban area weight maintenance

项目摘要

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.

项目总结/文摘