Randomized Trial of Exercise Promotion in Primary Care

初级保健中运动促进的随机试验

基本信息

批准号：
8762082
负责人：
Stephen Paul Fortmann
金额：
$ 25.21万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-01 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8762082
关键词：
Address Adult Advisory Committees African American American Behavioral Blindness Blood Glucose Blood Pressure Body Weight decreased Body mass index California Cardiovascular Diseases Cessation of life Clinical Preventive Practices Computerized Medical Record Counseling Data Diabetes Mellitus Disease Effectiveness of Interventions Elderly Exercise Glucose Glycosylated hemoglobin A Goals Guidelines Health Health Care Sector Health Personnel Health Planning Heart Diseases Hemoglobin Individual Insulin Intervention Intervention Studies Kidney Failure Knowledge Latino Lipids Lower Extremity Measures Metabolic Mexican Americans National Health and Nutrition Examination Survey Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Outcome Outpatients Patient Self-Report Patients Physical activity Population Prediabetes syndrome Prevalence Preventive Primary Health Care Provider Quality of life Randomized Recruitment Activity Risk Services Stroke System Telephone Testing Training Visit aged base brief advice cost cost effectiveness diabetes risk health care delivery high risk improved innovation intervention effect lifestyle intervention limb amputation meetings member motivational enhancement therapy neglect obesity risk peer primary care setting primary outcome public health relevance racial and ethnic randomized trial secondary outcome sedentary success treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Diabetes is a devastating disease that is increasing in prevalence. Regular physical activity markedly improves health for all individuals, including those with diabetes and pre-diabetes. However, only 5% of American adults are sufficiently active to meet U.S. national guidelines. The health sector is an important setting to promote physical activity because of its ability to reach and influence large numbers of people. Previous trials in the primary care setting have been hindered by short-term interventions, insufficient intervention intensity, self- reported physical activity as the outcome, and non-generalizability o results. We propose a trial including members of Kaiser Permanente Southern California (KPSC), an integrated health plan with high racial/ethnic diversity and whose majority membership is Latino. We will build on an existing KP innovation of assessing physical activity at every outpatient visit by proposing a trial in which the primary care provider determines the suitability of a patient to increase physical activity, provides brief advice, and refers patients or physical activity counseling. Eligible patients are then recruited to a 2-year, medium-intensity telephone behavioral counseling intervention or usual care. We focus the trial on adults who have pre-diabetes or diabetes who are not prescribed insulin because of their high risk for cardio-metabolic complications and the great benefit they can obtain from regular physical activity. The intervention, individualized by the motivational interviewing approach, is generalizable to other health care delivery systems. Electronic medical records will provide data for secondary outcomes. Our long-term goal is to determine if such a physical activity intervention can be successfully integrated into primary care services. If so, the intervention can be scaled so millions of sedentary patients with diabetes or pre-diabetes can receive personal advice and physical activity counseling. To this end, our primary aims is to determine if the study intervention, compared to usual care, increases physical activity (assessed by accelerometry) between baseline and 24 months in patients with type 2 diabetes or pre-diabetes. Our secondary aims are to 1) determine if the intervention improves body mass index (BMI), hemoglobin A1C, blood pressure, lipids, and quality of life, and 2) determine the cost-effectiveness of the intervention. This study has the potential for a very high impact on clinical preventive practices. Physical activity improves numerous diseases and conditions and is seriously neglected in primary care. By documenting the costs and effects of a practical intervention based in primary care on an objective measure of physical activity, this study will promote a highly significant shift in primary care practice.

描述（由申请人提供）：糖尿病是一种破坏性疾病，其患病率正在不断增加。定期的体育活动可以显着改善所有人的健康，包括糖尿病患者和糖尿病前期患者。然而，只有 5% 的美国成年人有足够的运动量来满足美国国家指导方针。卫生部门是促进身体活动的重要场所，因为它能够接触并影响大量人群。先前在初级保健机构进行的试验因短期干预、干预强度不足、自我报告的体力活动结果以及结果的不可推广性而受到阻碍。我们提议一项包括南加州凯撒医疗机构 (KPSC) 成员在内的试验，这是一项具有高度种族/族裔多样性的综合健康计划，其大多数成员是拉丁裔。我们将在现有的 KP 创新的基础上，在每次门诊就诊时评估身体活动，提出一项试验，由初级保健提供者确定患者是否适合增加身体活动，提供简短的建议，并转介患者或进行身体活动咨询。然后招募符合条件的患者接受为期 2 年的中等强度的电话行为咨询干预或常规护理。我们的试验重点是患有糖尿病前期或糖尿病的成年人，他们没有服用胰岛素，因为他们患心脏代谢并发症的风险很高，而且他们可以从定期的体育活动中获得巨大的好处。这种干预措施通过动机访谈方法进行个性化，可推广到其他医疗保健服务系统。电子病历将为次要结果提供数据。我们的长期目标是确定这种身体活动干预措施是否可以成功融入初级保健服务。如果是这样，干预措施可以扩大规模，以便数百万久坐的糖尿病或糖尿病前期患者可以获得个人建议和身体活动咨询。为此，我们的主要目标是确定与常规护理相比，研究干预是否增加了 2 型糖尿病或糖尿病前期患者在基线和 24 个月之间的体力活动（通过加速度测量法评估）。我们的次要目标是 1) 确定干预措施是否改善体重指数 (BMI)、糖化血红蛋白、血压、血脂和生活质量，以及 2) 确定干预措施的成本效益。这项研究有可能对临床预防实践产生非常大的影响。身体活动可以改善多种疾病和状况，但在初级保健中却被严重忽视。通过记录基于身体活动客观测量的初级保健实际干预措施的成本和效果，这项研究将促进初级保健实践的重大转变。