Online Counseling to Enable Lifestyle-focused Obesity Treatment in Primary Care

描述(申请人提供)：这项研究是在线咨询，旨在实现初级保健中以生活方式为重点的肥胖症治疗，旨在将基于证据的生活方式干预转化为初级保健环境，利用信息技术实现临床生活方式咨询。尽管美国预防服务工作组(USPSTF)建议临床医生对所有成年患者进行肥胖筛查，并提供强化咨询和行为干预，以促进肥胖成年人持续减肥，但强化生活方式咨询存在多种障碍，该建议尚未得到广泛实施。我们建议检查两种指导策略，以提供综合干预的在线版本，将饮食和锻炼建议与行为工具相结合。这 干预措施最初是为糖尿病预防计划(DPP)开发的，与USPSTF推荐的咨询方法一致，并已被证明在促进减肥方面有效。我们将患者随机分到三个研究小组中的一个，比较提供基于互联网的DPP干预的两种在线指导策略和第三种小组的效果，在第三小组中，为患者提供具体的生活方式目标和支持生活方式改变的社区资源的在线链接。通过要求医生转介，增加卫生保健团队获得行为专业知识的机会，并鼓励医生向参与其中的患者提供反馈，我们的目标是将生活方式问题纳入常规预防医学。在基于民进党干预的ARM中，基于互联网的方法允许我们将基于证据的密集咨询与相对较低的人员需求和在患者日程安排和地点偏好方面的非凡灵活性相结合。我们将检查体重、腰围、体力活动、生活质量的变化，并计算干预成本-效果。我们将通过使用可在常规实践中复制的招聘和遵守战略，以及为代表初级保健实践中雇用的教育工作者的工作人员提供咨询，来确保可持续性。如果在线战略是有效的，匹兹堡大学医疗中心卫生系统的广泛网络为支持该地区的传播提供了良好的基础设施。因此，这项研究可能促进当前循证预防医学指南的广泛采用，这些指南建议将强化生活方式干预纳入初级保健实践。

DESCRIPTION (provided by applicant): The study, Online counseling to enable lifestyle-focused obesity treatment in primary care, aims to translate an evidence-based lifestyle intervention into the primary care setting, using information technology to enable clinical lifestyle counseling. While the US Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults, multiple barriers to intensive lifestyle counseling exist and the recommendation has not been widely implemented. We propose to examine two coaching strategies for delivering an online version of a comprehensive intervention combining diet and exercise advice with behavioral tools. This intervention, originally developed for the Diabetes Prevention Program (DPP), is consistent with the counseling approach recommended by the USPSTF and has proven efficacy for promoting weight loss. We will randomize patients to one of three study arms, comparing the effect of the two online coaching strategies for delivering the Internet-based DPP intervention with a third arm in which patients are provided specific lifestyle goals and online links to community resources that support lifestyle change. By requiring physician referral, augmenting the health care team's access to behavioral expertise, and encouraging physician feedback to participating patients, we aim to integrate lifestyle issues into routine preventive medicine. In the arms based on the DPP intervention, an Internet-based approach allows us to combine intensive evidence-based counseling with relatively low staffing needs and extraordinary flexibility in terms of patients scheduling and location preferences. We will examine change in weight, waist circumference, physical activity, quality of life, and will calculate intervention cost- effectiveness. We will ensure sustainability by using recruitment and adherence strategies that can be replicated in routine practice, and counseling staff who are representative of the educators employed in primary care practice. If an online strategy is effective, the extensive network of the University of Pittsburgh Medical Center Health System provides excellent infrastructure for supporting dissemination in the region. As such, this study may facilitate wide-spread adoption of current evidence-based preventive medicine guidelines recommending incorporation of intensive lifestyle interventions into primary care practice.