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)

• 批准号: 10573294
• 负责人: Christie Befort
• 金额: $ 88.19万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 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/10573294
• 关键词: Address; Adoption; Adult; Affect; Area; Behavior; Behavioral; Body Weight decreased; Body mass index; Cancer Etiology; Cessation of life; Clinic; Clinic Visits; Code; Communities; Commuting; Consumption; County; Data; Diet; Disparity; Energy Intake; Environment; Evaluation; Evidence based treatment; Exercise; Fatty acid glycerol esters; Food; Geography; Guidelines; Health; High Prevalence; High-Risk Cancer; Home; Human Resources; Improve Access; Individual; Intervention; Kansas; Knowledge; Learning; 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; Prediction of Response to Therapy; Prevalence; Primary Care; Primary Care Physician; Process; Publishing; Quality of life; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Resources; Risk; Rural; Rural Community; Rural Population; Telemedicine; Telephone; Testing; Time; Tobacco; Transportation; Visit; Walking; Weight; Weight maintenance regimen; arm; bariatric surgery; built environment; cancer risk; cancer type; comorbidity; design; diabetes prevention program; effectiveness evaluation; experience; healthy lifestyle; implementation outcomes; improved; low socioeconomic status; novel; obesity treatment; obesogenic; patient engagement; patient-clinician communication; prevent; primary care clinic; primary care provider; programs; rural Americans; rural area; rural dwellers; rural health clinic; rural setting; secondary outcome; social culture; social disparities; sociodemographic factors; support network; team-based care; treatment as usual; treatment effect; treatment trial; uptake; urban area; weight maintenance

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.

项目摘要/摘要 肥胖增加了13种癌症的风险，现在影响美国成年人口的40％以上，甚至 粗糙的美国人的患病率更高。最担心的是，3类肥胖症的患病率（BMI≥40）， 在农村社区中，癌症风险最高的癌症风险最高的速度增加了3倍 到城市地区。农村居民通常无法获得体重控制计划，食物和体育锻炼 促进健康生活方式的资源，尤其是在小型或偏远的农村地区。肥胖至关重要 在粗糙的初级保健中提供治疗，尤其是到那些患有3级肥胖和/或共同的人 患有最高肥胖相关癌症风险的病态医疗状况。医疗管理 行为减肥期间的初级保健提供商（PCP）对于解决联合医学至关重要 条件，评估肥胖药物并探索指导原则的选择 药物治疗和手术治疗。但是，在初级保健中错过了机会 - 基于肥胖治疗试验，用于利用基于指南的医疗管理。当前的审判建造 在我们最近在农村初级保健诊所进行的重启试验中汲取的教训，该试验 通过临界组访问与单个访问，体重减轻明显更大，并突出显示 当地PCP的医疗管理需求。重新工厂（农村参与远程电视节目 肥胖治疗解决方案中的选项）是旨在的集群RCT（n = 16个诊所和560名参与者） 增强农村社区肥胖治疗的可持续接收。 TelemedTeam是一个新颖的团队 远程医疗方法，将密集型远程医疗访问与季度基于团队的诊所配对 访问仅吸引患者，当地的PCP和生活方式教练来帮助患者。 这种新颖的协作远程医疗解决方案结合了基于群体的治疗的好处 基于远程医疗的交付，并批判性地将基于团队的护理整合在当地的农村诊所中，以利用 医疗管理以及获得本地支持和资源的重要性。主要假设是 与增强的通常护理相比 仅由季度PCP访问组成。次要结果包括达到≥5％和10％的比例 体重减轻，饮食质量，体育锻炼，生活质量和医疗过程。探索性 分析将评估覆盖范围，采用和实施，并调查粗糙的社会文化和空间 预测治疗效果的因素。