Primary Care Obesity Management in the Southeast_PROMISE

 描述（由申请人提供）：初级保健为受肥胖影响的患者提供了一个熟悉和可访问的临床场所，以接受基于证据的生活方式干预，用于体重管理。然而，在初级保健中实施此类计划存在许多障碍，并且初级保健医生或医疗团队的其他成员提供的先前干预措施通常表现出患者的适度和暂时体重减轻。由训练有素的同伴教练提供的减肥治疗可以提供一个可行的和有效的替代方案，以解决初级保健中的体重管理。虽然同伴教练已经成功地为其他慢性病提供了行为干预（例如，2型糖尿病）以及非临床环境中的肥胖干预（例如，社区中心），研究是缺乏对翻译同行交付减肥干预措施的有效性，以初级保健。我们的初步工作表明，由同伴教练在初级保健中提供的减肥干预可以实现临床显著的体重减轻，在初级保健中采用是可行的，并且受到患者的欢迎。在本申请中，我们建议进行一项为期18个月的随机对照试验，比较肥胖治疗的效果，包括：1）与同伴教练的面对面和电话联系（同伴教练治疗），或2）与初级保健提供者的常规联系加上自我指导的干预材料（标准护理）。这项减肥试验将包括375名肥胖成年人，他们是从10个初级保健机构随机挑选出来的。主要结局是第18个月时体重的变化。次要结局将包括以患者为中心的关键结局，包括生活质量、身体和社会功能、情绪和治疗满意度。同侪教练干预的成本效益也将进行评估。这是一个新的调查的有效性和可持续性的创新替代肥胖治疗提供初级保健。如果同伴教练干预被证明是有效的，它将对患者、临床医生和卫生系统产生重大的临床和公共卫生影响。这些潜在的好处包括：1）改善患者的临床和心理社会结局，2）增加初级保健提供者管理肥胖患者护理的治疗选择，3）降低医疗保健利用率和成本。

 DESCRIPTION (provided by applicant): Primary care offers a familiar and accessible clinical venue for patients affected by obesity to receive evidence- based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous interventions delivered by primary care physicians or other members of the healthcare team have often demonstrated modest and temporary weight loss for patients. Weight loss treatment delivered by trained peer coaches may offer a viable and effective alternative to address weight management in primary care. While peer coaches have successfully delivered behavioral interventions for other chronic conditions (e.g., type 2 diabetes) as well as obesity interventions in non-clinical settings (e.g., community centers), research is lacking on the effectiveness of translating peer- delivered weight loss interventions to primary care. Our preliminary work suggests that a weight loss intervention delivered in primary care by peer coaches can achieve clinically significant reductions in weight, is feasible for adoption in primary care, and is well-received by patients. In this application, we propose to conduct an 18-month randomized controlled trial comparing the effects of obesity treatment that includes either: 1) in-person and telephone-based contacts with peer coaches (peer coach treatment), or 2) routine contact with a primary care provider plus self-directed intervention materials (standard care). This weight loss trial will include 375 obese adults randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost- effectiveness of the peer coach intervention will also be evaluated. This is a novel investigation of the effectiveness and sustainability of an innovative alternative for obesity treatment delivery in primary care. If the peer coach intervention proves effective, it would have significant clinical and public health implications for patients, clinicians, and health systems. These potential benefits include: 1) improvement of clinical and psychosocial outcomes for patients, 2) increased treatment options for primary care providers to manage the care of obese patients, and 3) reduced healthcare utilization and costs.