Rural Engagement in TelemedTeam for Options in Obesity Treatment Solutions (RE-TOOL)

农村参与远程医疗团队寻求肥胖治疗解决方案选择 (RE-TOOL)

• 批准号: 10372530
• 负责人: Christie Befort
• 金额: $ 90.03万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10372530
• 关键词: Address; Adoption; Adult; Affect; Area; Behavior; Behavioral; Body Weight decreased; Body mass index; Cancer Etiology; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinic; Clinic Visits; Code; Communities; Commuting; Consumption; County; Data; Diet; Energy Intake; Environment; Evaluation; Evidence based treatment; Fatty acid glycerol esters; Food; Geography; Guidelines; Health; High Prevalence; High-Risk Cancer; Home; Human Resources; Improve Access; Individual; Intervention; Kansas; Knowledge; Lead; Life Style; Maintenance; Malignant Neoplasms; Measures; Medical; Obesity; Obesity associated cancer; Office Visits; Operative Surgical Procedures; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physical activity; Plants; Population; Prevalence; Primary Care Physician; Primary Health Care; Process; Publishing; Quality of life; Reach Effectiveness Adoption Implementation and Maintenance; Resources; Risk; Rural; Rural Community; Rural Population; Telemedicine; Telephone; Testing; Time; Tobacco; Transportation; Visit; Walking; Weight; Weight maintenance regimen; arm; bariatric surgery; base; built environment; cancer risk; cancer type; care providers; comorbidity; design; diabetes prevention program; effectiveness evaluation; experience; healthy lifestyle; implementation outcomes; low socioeconomic status; novel; obesity treatment; obesogenic; patient-clinician communication; prevent; programs; rural Americans; rural area; rural dwellers; rural setting; secondary outcome; social culture; social disadvantage; sociodemographic factors; support network; treatment as usual; treatment effect; treatment trial; uptake; urban area; weight maintenance

PROJECT SUMMARY/ABSTRACT Obesity increases risk for 13 types of cancer and now affects over 40% of the U.S. adult population, with even higher prevalence among rural Americans. Most worrisome, the prevalence of class 3 obesity (BMI ≥ 40), which contributes the highest cancer risk, is increasing at a rate 3 times higher in rural communities compared to urban areas. Rural residents often lack access to weight control programs and food and physical activity resources that promote healthy lifestyles, especially in small or remote rural areas. It is paramount that obesity treatment be offered in rural primary care, especially to reach those who have Class 3 obesity and/or co- morbid medical conditions who carry the highest obesity-related cancer risk. Medical management by a primary care provider (PCP) during behavioral weight loss is essential to address co-morbid medical conditions, evaluate obesogenic medications, and explore options for guideline-recommended pharmacotherapy and surgical treatment. However, there has been a missed opportunity in primary care- based obesity treatment trials for capitalizing on guideline-based medical management. The current trial builds on lessons learned in our recently completed RE-POWER trial conducted in rural primary care clinics, which demonstrated significantly greater weight loss with in-clinic group visits versus individual visits, and highlighted the need for medical management by the local PCPs. RE-TOOL (Rural Engagement in TelemedTeam for Options in Obesity Treatment SoLutions) is a cluster RCT (n = 16 clinics and 560 participants) designed to enhance sustainable access to obesity treatment in rural communities. TelemedTeam is a novel team-based telemedicine approach that pairs intensive telemedicine group visits with quarterly individual team-based clinic visits that simultaneously engage the patient, the local PCP, and the lifestyle coach to help activate the patient. This novel collaborative telemedicine solution combines the benefits of group-based treatment with home- based telemedicine delivery, and critically, integrates team-based care in local rural clinics to capitalize on the importance of medical management and access to local support and resources. The primary hypothesis is that TelemedTeam will result in greater % weight loss at 24 months compared to Enhanced Usual Care consisting of quarterly PCP visits only. Secondary outcomes include the proportion achieving ≥5% and 10% weight loss, diet quality, physical activity, quality of life, and medical treatment process outcomes. Exploratory analyses will assess reach, adoption, and implementation and investigate rural sociocultural and spatial predictors of treatment effects.

项目概要/摘要 肥胖会增加患 13 种癌症的风险，目前影响着超过 40% 的美国成年人口，甚至 美国农村地区的患病率较高，最令人担忧的是 3 级肥胖（BMI ≥ 40）的患病率， 其癌症风险最高，在农村社区的增长速度是其三倍 农村居民往往缺乏体重控制计划以及食物和身体活动。 促进健康生活方式的资源，特别是在小型或偏远农村地区，肥胖问题至关重要。 在农村初级保健中提供治疗，特别是针对那些患有 3 级肥胖症和/或患有肥胖症的人 与肥胖相关的癌症风险最高的病态医疗状况。 行为减肥期间的初级保健提供者（PCP）对于解决共病医疗至关重要 条件，评估致肥胖药物，并探索指南推荐的选择 然而，初级保健却错失了机会。 基于指南的医疗管理的肥胖治疗试验。 我们最近在农村初级保健诊所进行的 RE-POWER 试验中吸取了经验教训，该试验 与单独就诊相比，临床团体就诊的体重减轻明显更大，并强调 当地 PCP 进行医疗管理的需要 RE-TOOL（远程医疗团队的农村参与）。 肥胖治疗解决方案选项）是一项集群随机对照试验（n = 16 家诊所和 560 名参与者），旨在 TelemedTeam 是一个基于团队的新型团队，旨在提高农村社区获得肥胖症治疗的可持续机会。 将密集远程医疗小组就诊与每季度个人团队诊所相结合的远程医疗方法 患者、当地 PCP 和生活方式教练同时参与的访问，以帮助激活患者。 这种新颖的协作远程医疗解决方案结合了基于团体的治疗和家庭治疗的优点 远程医疗服务，最重要的是，将基于团队的护理整合到当地农村诊所，以利用 医疗管理和获得当地支持和资源的重要性主要假设是： 与增强型日常护理相比，TelemedTeam 将在 24 个月时实现更高的体重减轻百分比 仅包括季度 PCP 就诊的次要结果包括达到 ≥5% 和 10% 的比例。 体重减轻、饮食质量、体力活动、生活质量和探索性医疗过程结果。 分析将评估影响范围、采用和实施，并调查农村社会文化和空间 治疗效果的预测因素。