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，超重和肥胖患者向初级保健提供者 (PCP) 进行的 7.5 亿次就诊中，大约有 700 次没有任何体重咨询。造成这种情况的主要原因是，PCP 缺乏帮助患者减肥的培训，而且初级保健机构没有持续有效的干预措施。尽管面对面和基于电话的体重控制计划很难在初级保健中传播，但在线体重控制计划越来越有效，并且可能适合在这些环境中使用。鉴于针对肥胖和初级保健中常见的其他病症（例如抑郁、失眠）的有效在线计划数量不断增加，了解这些计划在纳入初级保健时是否有效以及是否通过提供者的参与而得到加强非常重要。对初级保健行为改变 5A 模型的研究表明，初级保健干预措施最有效但最少使用的特征是安排随访，其中提供者让患者负责坚持治疗并实现特定结果。我们创建了一种简单的方法，将互联网体重控制计划整合到初级保健环境中，允许 PCP 监控患者的依从性和结果，并通过电子邮件向他们发送预先写好的、定制的后续信息。我们试点工作中的 PCP 相信，这将有助于克服帮助患者减肥的关键障碍。在这项研究中，我们建议招募 27 名 PCP 和 540 名患者，并将他们随机分配到以下三种情况之一，以测试将有效的自动化互联网体重控制计划整合到初级保健中的影响：A) 简短的医生咨询 + 常规护理， B) 简短的医生咨询 + 转介和访问互联网体重控制计划以及 C) 简短的医生咨询 + 转介和访问互联网体重控制计划 + 来自 PCP 的支持和问责的简短后续电子邮件说明。我们假设条件 C 与条件 B [5.0 公斤 (SD = 6.0) 比 3.0 公斤 (SD = 4.0)] 和条件 B 与条件 A [3.0 公斤 (SD = 4.0) 相比，12 个月后的平均体重减轻会更大。 v. 1.0 kg (SD = 3.0)] 并且体重减轻将与责任感、登录、饮食和身体活动行为的变化相关。确定利用医患关系来提高患者依从性和在线项目结果的方法（例如提议的方法）可能会对公共卫生产生重大影响。