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：
8876673
负责人：
Stephen Paul Fortmann
金额：
$ 26.27万
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 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8876673
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 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）：糖尿病是一种毁灭性疾病，患病率正在增加。定期的体育锻炼明显改善了所有人的健康，包括患有糖尿病和糖尿病前的人。但是，只有5％的美国成年人足以满足美国国家准则。卫生部门是促进体育锻炼的重要环境，因为它具有触及和影响大量人的能力。短期干预措施，干预强度不足，自我报告的身体活动作为结果和非能剂o结果，在初级保健环境中的先前试验受到了阻碍。我们提出了一项试验，其中包括Kaiser Permanente南加州（KPSC）的成员，该计划是一项具有高种族/种族多样性的综合健康计划，其大多数成员是拉丁裔。我们将在每次门诊就诊时评估体育锻炼的现有创新基础，通过提出一项试验，其中初级保健提供者确定患者提高体育锻炼的适用性，提供简短的建议，并转介患者或体育锻炼咨询。然后将合格的患者招募到2年中强度的电话行为咨询干预或通常的护理。我们将试验重点放在患有糖尿病前或糖尿病的成年人，因为他们的心脏代谢并发症的高风险以及他们可以从常规的体育锻炼中获得的巨大好处，因此未开处方胰岛素。通过动机访谈方法个性化的干预措施可以推广到其他医疗保健提供系统。电子病历将为次要结果提供数据。我们的长期目标是确定是否可以成功地集成到初级保健服务中。如果是这样，干预可以进行缩放，以便数百万久坐的糖尿病或糖尿病前患者可以获得个人建议和体育锻炼咨询。为此，我们的主要目的是确定在2型糖尿病或糖尿病前患者中，与常规护理相比，研究干预是否会增加基线和24个月之间的体育锻炼（通过加速度测定法评估）。我们的次要目的是1）确定干预措施是否改善了体重指数（BMI），血红蛋白A1C，血压，脂质和生活质量以及2）确定干预的成本效益。这项研究有可能对临床预防实践产生很大影响。体育活动可以改善许多疾病和病情，并在初级保健中被严重忽视。通过记录基于初级保健的实际干预措施的成本和影响，这项研究将促进初级保健实践的高度显着转变。