Impact of Integrating an Internet Weight Control Program into Primary Care

描述(由申请人提供)：每年，超重和肥胖患者到初级保健提供者(PCP)就诊的7.5亿人次中，大约有7亿人次没有进行任何体重咨询。造成这种情况的主要原因是，初级保健医生没有接受过帮助他们的患者减肥的培训，而且初级保健环境中没有始终如一的有效干预措施。尽管面对面和基于电话的体重控制计划很难在初级保健中传播，但在线体重控制计划越来越有效，可能会在这些环境中使用。鉴于针对肥胖和初级保健中出现的其他疾病(例如抑郁、失眠)的有效在线方案的数量不断增加，了解这些方案在纳入初级保健时是否有效以及提供者的参与是否会增强这些方案是很重要的。对5A初级保健行为改变模型的研究表明，初级保健干预最有效、但使用最少的功能是安排随访，提供者要求患者对坚持治疗和实现特定结果负责。我们创建了一种简单的方法，将互联网体重控制计划整合到初级保健设置中，允许PCP监控患者的依从性和结果，并通过电子邮件向他们发送预先编写的、量身定制的后续消息。我们试点工作中的PCP相信，这将有助于克服帮助他们的患者减肥的关键障碍。在这项研究中，我们建议通过招募27名PCP和他们的540名患者并将他们随机分为三种情况之一来测试将有效的自动化互联网体重控制计划整合到初级保健中的影响：A)简短的医生咨询+常规护理，B)简短的医生咨询+推荐并访问互联网体重控制计划，C)简短的医生咨询+推荐和访问互联网体重控制计划+来自PCP的支持和责任的简短跟踪电子邮件笔记。我们假设，12个月后，条件C与B[5.0 kg(SD=6.0)vs.3.0 kg(SD=4.0)]和条件B vs.A[3.0 kg(SD=4.0)vs.1.0 kg(SD=3.0)]的平均体重下降会更大，体重下降将与责任感、登录、饮食和体育活动行为的变化有关。确定利用医患关系来改善患者依从性和在线项目结果的方法，如提议的方法，可能会对公共卫生产生重大影响。

DESCRIPTION (provided by applicant): Every year, roughly 700 of the 750 million visits that overweight and obese patients make with primary care providers (PCPs) occur without any weight counseling. The main reasons for this are that PCPs are poorly trained to help their patients lose weight and that there are no consistently effective interventions for primary care settings. Though in-person and telephone- based weight control programs have been difficult to disseminate in primary care, online weight control programs are increasingly effective and may lend themselves to be used in these settings. Given the growing number of effective online programs, for obesity and for other conditions seen in primary care (e.g., depression, insomnia) it is important to understand whether these programs can be effective when integrated into primary care and whether they are enhanced by provider involvement. Research on the 5 A's model of primary care behavior change suggests that the most effective, yet least used feature of primary care interventions is arranging follow-up, where providers hold patients accountable to adhering to treatments and achieving specific outcomes. We have created a simple method for integrating an Internet weight control program into primary care settings, by allowing PCPs to monitor their patients' adherence and outcomes and email them pre-written, tailored follow-up messages. PCPs in our pilot work believed that this would help to overcome key barriers to helping their patients lose weight. In this study, we propose to test the impact of integrating an effective automated Internet weight control program into primary care, by recruiting 27 PCPs and 540 of their patients and randomizing them to one of three conditions: A) Brief physician counseling + Usual care, B) Brief physician counseling + Referral and access to a the Internet weight control program and C) Brief physician counseling + Referral and access to the Internet weight control program + brief follow-up email notes of support and accountability from PCPs. We hypothesize that mean weight losses after 12 months will be greater in Condition C v B [5.0kg (SD = 6.0) v. 3.0kg (SD = 4.0)] and in Condition B v. A [3.0kg (SD = 4.0) v. 1.0 kg (SD = 3.0)] and that weight loss will be associated with changes in accountability, logins, eating and physical activity behaviors. Identifying ways, such as proposed, to leverage the doctor-patient relationship to improve patient adherence and outcomes from online programs could have a significant public health impact.