Linking Self-Management and Primary Care for Diabetes

描述（由申请人提供）：迫切需要研究能够转化为糖尿病和其他慢性疾病自我管理实践的行为干预措施。绝大多数糖尿病自我管理研究都是在学术环境中进行的，并没有解决真实的世界应用问题或初级保健实践的挑战和背景。有充分证据表明，提供给糖尿病患者的预防性护理是次优的，并且大多数患者特别需要糖尿病自我管理的行为改变方面的帮助。基于目前的文献，理论和我们以前的疗效研究的经验教训，这种竞争性的更新应用程序将通过改进和实验评估一种实用的，基于计算机的（结合互联网和自动电话）糖尿病自我管理干预来解决这些问题。该干预措施旨在促进饮食和身体活动实践，药物服用和患者激活糖尿病护理。在一项有效性研究中，来自HMO和混合支付者环境中的初级保健提供者的总共425名2型糖尿病患者将被随机分配到三种条件之一：（1）加强日常护理;（2）我们的社会生态学的第二代版本，基于理论的行为干预，以最大限度地与初级保健和社区资源联系，加上加强人际支持;或（3）这种干预的完全自动化版本。这两项积极的干预措施将分别包括几个创新的组成部分，以解决覆盖范围，低健康素养，多种健康行为的改变，持续参与加班，社会环境支持和维护/复发预防策略。评估将是全面的，并基于RE-AIM模型的范围，有效性，采用，实施和维护方面。我们将采用新的指标来解决健康差异、任何不利影响和实施成本等问题。关键结果将包括行为改变（饮食，体力活动和药物服用）和UKPDS多重风险公式，该公式结合了几种心脏病风险因素（HbA 1c，血压，吸烟和血脂）。我们将包括一个复杂的成本和成本效益分析。关键次要结局和过程测量将包括6个月和12个月随访时的糖尿病特异性生活质量、患者激活和感知的社会环境支持。这样一个实际有效性试验的结果，进行了具有代表性的样本的初级保健患者从异质性的做法，并强调内部和外部的有效性标准，具有重要的意义，既为科学的行为改变和翻译研究实践。

DESCRIPTION (provided by applicant): There is a pressing need for research on behavioral interventions capable of being translated into practice for the self-management of diabetes and other chronic illnesses. The vast majority of diabetes self-management research has been conducted in academic settings, and has not addressed real world application issues or the challenges and context of primary care practice. It is well-documented that preventive care provided to diabetes patients is suboptimal, and that most patients are especially in need of assistance with behavior- change aspects of diabetes self-management. Based on the current literature, theory, and lessons from our previous efficacy research, this competing renewal application will address these issues by refining and experimentally evaluating a practical, computer-based (combined Internet and automated telephone) diabetes self-management intervention For primary care patients. The intervention is designed to facilitate dietary and physical activity practices, medication-taking, and patient activation around diabetes care. A total of 425 type 2 diabetes patients from primary care providers in HMO and mixed-payer settings will be randomly assigned to one of three conditions in an effectiveness study: (1) enhanced usual care; (2) a second generation version of our social-ecological, theory- based behavioral intervention to maximize linkage with primary care and community resources, plus enhanced interpersonal support; or (3) an entirely automated version of this intervention. The two active interventions will each include several innovative components to address reach, low health literacy, change in multiple health behaviors, continued participant involvement overtime, social environmental support, and maintenance/relapse prevention strategies. Evaluation will be comprehensive and based on the RE-AIM model dimensions of reach, effectiveness, adoption, implementation, and maintenance. We will employ new metrics to address issues such as health disparities, any adverse effects, and implementation costs. Key outcomes will include behavior change (dietary, physical activity, and medication-taking) and the UKPDS multiple risk formula that combines several heart disease risk factors (HbA1c, blood pressure, smoking, and lipids). We will include a sophisticated cost and cost- effectiveness analysis. Key secondary outcomes and process measures will include diabetes-specific quality of life, patient activation, and perceived social-environmental support at 6- and 12-month follow-ups. The results of such a practical effectiveness trial, conducted with a representative sample of primary care patients from heterogeneous practices, and emphasizing both internal and external validity criteria, has important implications both for the science of behavior change and for translating research to practice.