Enhancing Diabetes and Hypertension Self-Management for Rural Appalachian Patients In Patient-Centered Medical Homes

西弗吉尼亚州的糖尿病和高血压患病率在全国排名第一和第二。然而，许多农村患者 患有糖尿病和高血压的患者得不到提供者的自我管理支持。 这个R34规划项目的目标是测试一个文化定制的、 多模式、为期6周的修订糖尿病和高血压自我管理计划(M-DHSMP)，将 纳入以证据为基础的饮食、体力活动和服药依从性的关键要素(与药物一起 治疗管理或MTM)。M-DHSMP是根据循证课程 美国糖尿病教育者协会(AADE-7)和JNC指南。75名成年人患有 糖尿病和高血压的共病将从西弗吉尼亚州北部的县和 按1：1：1的比例随机化。我们建议进行一项三臂随机对照试验(RCT)来比较 6周M-DHSMP核心干预(饮食和体力活动；n=25)，6周M-DHSMP核心加 在两个地理位置不同的患者中，25人坚持服用MTM(n=25)或加强日常护理(EUC) 以患者为中心的医疗之家(PCMH)我们将使用源自以下内容的后回归分解技术 计量经济学领域，研究关键因素(饮食、体力活动和 服药依从性)导致临床结果(糖化血红蛋白和血压)之间的差异 两组(M-DHSMP核心和M-DHSMP核心加用药依从性)。此外，我们将使用定性的 重点小组和RE-AIM评估框架，以评估以下项目的覆盖范围、有效性、采用率和可持续性 行为改变，以及参与者对计划的体验和满意度。行为的衡量标准 变化将包括饮食摄入量、体力活动、服药依从性、使用调查、食物/活动日志 和处方配药报告。与我们之前的研究一样，训练有素的健康教练(HCS)将管理 计划并提供每周跟踪指导，查看食物/活动日志以获得持续反馈和 强化健康教育信息。对独立效应和综合效应的理解 糖尿病患者的关键健康行为成分和行为矫正的作用/采用 高血压可以在现实环境中验证自我管理干预模型，以减少 代谢风险。干预的长期效果将在随后的R01临床试验中进行评估。 该项目建立在PI之前在农村成功的基于社区的生活方式干预研究基础上 阿巴拉契亚和印度农村。

West Virginia ranks 1st & 2nd nationally in the prevalence of diabetes and hypertension. Yet many rural patients with comorbid diabetes and hypertension do not receive self-management support from their providers. The goal of this R34 planning project is to test the feasibility and acceptability of a culturally-tailored, multimodal, 6-week modified Diabetes and Hypertension Self-Management Program (M-DHSMP), that will incorporate evidence-based key elements of diet, physical activity and medication adherence (with medication therapy management or MTM). The M-DHSMP is an adaptation of the evidence-based curriculum of the American Association of Diabetes Educator (AADE-7) and the JNC guidelines. Seventy five adults with comorbid diabetes and hypertension will be recruited from the northern counties of West Virginia and randomized with a 1:1:1 ratio. We propose to conduct a 3-arm randomized controlled trial (RCT) to compare the 6-week M-DHSMP core intervention (diet and physical activity; n=25), 6-week M-DHSMP core plus medication adherence with MTM (n=25) or enhanced usual care (EUC); n=25) in two geographically separated Patient Centered Medical Homes (PCMH). We will use post-regression decomposition technique derived from the field of econometrics to examine the extent to which key components (diet, physical activity, and medication adherence) contribute to the differences in clinical outcomes (HbA1c and blood pressure) between groups (M-DHSMP core and M-DHSMP core plus medication adherence). In addition, we will use qualitative focus groups and the RE-AIM evaluation framework to evaluate the reach, efficacy, adoption, sustainability of behavior changes, and participants’ experience and satisfaction with the program. Measures of behavioral changes will include dietary intake, physical activity, medication adherence, using surveys, food /activity logs and prescription filling reports. As in our prior studies, trained Health Coaches (HCs) will administer the program and provide weekly follow-up coaching, review food/activity logs for continuous feedback and reinforcement of health education messages. An understanding of the independent and combined effects of key health behavior components and the role of/adoption of behavior modifications in patients with diabetes and hypertension can validate self-management interventions models in real-world settings to reduce the metabolic risk. The longer term effects of the intervention will be evaluated in a subsequent R01 clinical trial. The project builds on the PI’s successful prior community-based lifestyle intervention studies in rural Appalachia and rural India.