Impact of Integrating an Internet Weight Control Program into Primary Care

将互联网体重控制计划纳入初级保健的影响

• 批准号: 8676785
• 负责人: CHRISTOPHER N. SCIAMANNA
• 金额: $ 62.08万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2015-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676785
• 关键词: Accountability; Address; Adult; Anxiety; Behavior; Body Weight decreased; Consumption; Counseling; Eating; Electronic Mail; Enrollment; Feedback; Future; Hand; Human; Human Resources; Internet; Intervention; Mental Depression; Meta-Analysis; Methods; Modeling; Monitor; Obesity; Online Systems; Outcome; Overweight; Patients; Persons; Physical activity; Physicians; Pilot Projects; Positioning Attribute; Primary Health Care; Professional counselor; Provider; Public Health; Randomized; Readiness; Recruitment Activity; Research; Services; Sleeplessness; Smoking Cessation Intervention; Telephone; Testing; Time; Training; Visit; Weight; Weight maintenance regimen; Work; Writing; base; behavior change; clinically significant; compliance behavior; effective intervention; efficacy testing; falls; follow-up; improved; prevent; primary care setting; programs; treatment as usual

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.

描述（由申请人提供）：每年，超重患者与初级保健提供者（PCP）进行的7.5亿次访问中，大约有700个没有任何体重咨询。造成这种情况的主要原因是PCP经过训练很差，可以帮助患者减肥，并且在初级保健环境中没有一贯的有效干预措施。尽管在初级保健中很难传播面对面和基于电话的体重控制计划，但在线体重控制计划越来越有效，并且可能在这些情况下使用自己。鉴于有效的在线计划越来越多，对于肥胖和初级保健中的其他状况（例如，抑郁症，失眠），重要的是要了解这些计划在整合到初级保健中是否可以有效，以及提供者参与是否会增强它们。对5A的初级保健行为变化模型的研究表明，初级保健干预措施的最有效但最不使用的特征是安排随访，在这种情况下，提供者使患者负责遵守治疗并实现特定结果。我们创建了一种简单的方法，可以通过允许PCP监视其患者的依从性和结果并通过电子邮件发送给他们预先编写的，量身定制的后续消息，将Internet重量控制程序集成到初级保健设置中。 PCP在我们的飞行员工作中认为，这将有助于克服帮助患者减肥的关键障碍。 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 PCP。我们假设在12个月后的平均体重减轻将更大，条件C V B [5.0kg（SD = 6.0）v。3.0kg（SD = 4.0）]和条件Bv。A[3.0kg（SD = 4.0）v。1.0kg（SD = 3.0），该体重损失与账单，均值，均等，饮食和物质性活动相关。确定诸如建议的方法，以利用医生的关系来提高患者的依从性和在线计划的结果可能会产生重大的公共卫生影响。