Enhancing Diabetes and Hypertension Self-Management for Rural Appalachian Patients In Patient-Centered Medical Homes

在以患者为中心的医疗之家中加强阿巴拉契亚农村患者的糖尿病和高血压自我管理

• 批准号: 10237312
• 负责人: RANJITA MISRA
• 金额: $ 19万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237312
• 关键词: 3-Dimensional; Address; Adherence; Adoption; Adult; American; Behavior Therapy; Behavioral; Benchmarking; Biological Markers; Blood Glucose; Blood Pressure; Chronic Disease; Clinical; Clinical Trials; Communities; Complex; Counseling; County; Diabetes Mellitus; Diet; Dietary intake; Disease; Disease Management; Education; Educational Curriculum; Elements; Enrollment; Evaluation; Evidence based intervention; Feedback; Focus Groups; Food; Geography; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health behavior; Health education; High Density Lipoprotein Cholesterol; Home; Hypertension; India; Intervention; Intervention Studies; Knowledge; LDL Cholesterol Lipoproteins; Life Style; Life Style Modification; Lipids; Maintenance; Measures; Medical center; Medication Management; Mental Depression; Metabolic; Methods; Modeling; Morbidity - disease rate; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Recruitments; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pharmacy facility; Physical activity; Population; Positioning Attribute; Poverty; Poverty Areas; Prevalence; Provider; Psychological reinforcement; Randomized; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Records; Reporting; Research; Risk; Role; Rural; Rural Appalachia; Self Management; Service delivery model; Site; Surveys; Techniques; Testing; Triglycerides; West Virginia; acceptability and feasibility; arm; base; behavior change; behavior measurement; blood lipid; cardiovascular disorder risk; community partnership; comorbidity; cost; diabetes distress; diabetes educator; diabetes self-management; econometrics; efficacy evaluation; eligible participant; empowerment; evidence base; evidence based guidelines; experience; feasibility testing; follow-up; health related quality of life; health training; healthy lifestyle; improved; intervention effect; lifestyle intervention; medically underserved; medication compliance; mortality; multimodality; nutrition; patient oriented; pedometer; programs; psychologic; recruit; retention rate; rural area; rural patients; satisfaction; self-management program; skills; social; social health determinants; treatment as usual; underserved area; usual care arm

West Virginia ranks 1st & 2nd nationally in the prevalence of diabetes and hypertension. Yet many rural patients with comorbid diabetes and hypertension do not receive self-management support from their providers. The goal of this R34 planning project is to test the feasibility and acceptability of a culturally-tailored, multimodal, 6-week modified Diabetes and Hypertension Self-Management Program (M-DHSMP), that will incorporate evidence-based key elements of diet, physical activity and medication adherence (with medication therapy management or MTM). The M-DHSMP is an adaptation of the evidence-based curriculum of the American Association of Diabetes Educator (AADE-7) and the JNC guidelines. Seventy five adults with comorbid diabetes and hypertension will be recruited from the northern counties of West Virginia and randomized with a 1:1:1 ratio. We propose to conduct a 3-arm randomized controlled trial (RCT) to compare the 6-week M-DHSMP core intervention (diet and physical activity; n=25), 6-week M-DHSMP core plus medication adherence with MTM (n=25) or enhanced usual care (EUC); n=25) in two geographically separated Patient Centered Medical Homes (PCMH). We will use post-regression decomposition technique derived from the field of econometrics to examine the extent to which key components (diet, physical activity, and medication adherence) contribute to the differences in clinical outcomes (HbA1c and blood pressure) between groups (M-DHSMP core and M-DHSMP core plus medication adherence). In addition, we will use qualitative focus groups and the RE-AIM evaluation framework to evaluate the reach, efficacy, adoption, sustainability of behavior changes, and participants’ experience and satisfaction with the program. Measures of behavioral changes will include dietary intake, physical activity, medication adherence, using surveys, food /activity logs and prescription filling reports. As in our prior studies, trained Health Coaches (HCs) will administer the program and provide weekly follow-up coaching, review food/activity logs for continuous feedback and reinforcement of health education messages. An understanding of the independent and combined effects of key health behavior components and the role of/adoption of behavior modifications in patients with diabetes and hypertension can validate self-management interventions models in real-world settings to reduce the metabolic risk. The longer term effects of the intervention will be evaluated in a subsequent R01 clinical trial. The project builds on the PI’s successful prior community-based lifestyle intervention studies in rural Appalachia and rural India.

西弗吉尼亚州在全国糖尿病和高血压患病率中排名第一和第二。然而，许多农村患者 患有糖尿病和高血压的患者没有从他们的提供者那里得到自我管理的支持。 这个R34规划项目的目标是测试一个文化定制的， 多模式，6周的改良糖尿病和高血压自我管理计划（M-DHSMP），将 纳入饮食、体育活动和药物依从性（与药物治疗）等循证关键要素 治疗管理或MTM）。该M-DHSMP是一个适应的证据为基础的课程， 美国糖尿病教育者协会（AADE-7）和JNC指南。75名成人， 将从西弗吉尼亚州的北方县招募糖尿病和高血压共病患者， 以1：1：1的比例随机分配。我们建议进行一项3组随机对照试验（RCT）， 6周M-DHSMP核心干预（饮食和体力活动; n=25），6周M-DHSMP核心加 MTM（n=25）或加强常规护理（EUC）的药物依从性; n=25）在两个地理上分离的 以病人为中心的医疗之家（PCMH）。我们将使用后回归分解技术， 计量经济学领域，以检查在多大程度上，关键组成部分（饮食，身体活动， 药物依从性）导致了以下患者之间临床结局（HbA 1c和血压）的差异： 组（M-DHSMP核心和M-DHSMP核心加药物依从性）。此外，我们将使用定性 焦点小组和RE-AIM评估框架，以评估 行为变化，以及参与者的体验和对计划的满意度。行为测量 变化将包括饮食摄入、体力活动、药物依从性、使用调查、食物/活动日志 和处方填写报告与我们之前的研究一样，经过培训的健康教练（HC）将管理 计划并提供每周的后续指导，审查食物/活动日志以获得持续的反馈， 加强健康教育信息。了解以下因素的独立和综合影响： 糖尿病患者的关键健康行为成分和行为改变的作用/采用 高血压可以在现实世界中验证自我管理干预模型，以减少 代谢风险干预的长期效果将在随后的R 01临床试验中进行评价。 该项目建立在PI先前在农村成功开展的基于社区的生活方式干预研究的基础上 阿巴拉契亚和印度乡村。