Impact of Integrating an Internet Weight Control Program into Primary Care

描述（由申请人提供）：每年，在7.5亿超重和肥胖患者就诊的初级保健提供者（pcp）中，大约有700人没有任何体重咨询。造成这种情况的主要原因是pcp在帮助患者减肥方面训练不足，而且初级保健机构没有一贯有效的干预措施。虽然面对面和以电话为基础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，可以在这些环境中使用。鉴于针对肥胖和初级保健中的其他疾病（如抑郁症、失眠）的有效在线项目越来越多，了解这些项目在整合到初级保健中时是否有效以及是否通过提供者的参与来增强它们是很重要的。对5a初级保健行为改变模型的研究表明，初级保健干预措施中最有效、但使用最少的特征是安排随访，在随访中，提供者让患者对坚持治疗和取得特定结果负责。我们创造了一种简单的方法，将互联网体重控制程序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、量身定制的后续信息。在我们的试点工作中，pcp相信这将有助于克服帮助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540名患者，并将他们随机分配到三种情况之一，来测试将有效的自动化互联网体重控制程序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+转诊和访问互联网体重控制计划；C)简短的医生咨询+转诊和访问互联网体重控制计划+简短的后续电子邮件记录，来自pcp的支持和责任。我们假设，12个月后，C组和B组[5.0kg (SD = 6.0) vs . 3.0kg (SD = 4.0)]和B组vs . A组[3.0kg (SD = 4.0) vs . 1.0 kg (SD = 3.0)]的平均体重减轻幅度更大，体重减轻将与问责制、登录、饮食和体育活动行为的变化有关。确定方法，如建议，利用医患关系来提高患者依从性和在线项目的结果，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.