Enhancing Diabetes and Hypertension Self-Management for Rural Appalachian Patients In Patient-Centered Medical Homes

在以患者为中心的医疗之家中加强阿巴拉契亚农村患者的糖尿病和高血压自我管理

基本信息

批准号：
10237312
负责人：
RANJITA MISRA
金额：
$ 19万
依托单位：
WEST VIRGINIA UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10237312
关键词：
3-Dimensional Address Adherence Adoption Adult American Behavior Therapy Behavioral Benchmarking Biological Markers Blood Glucose Blood Pressure Chronic Disease Clinical Clinical Trials Communities Complex Counseling County Diabetes Mellitus Diet Dietary intake Disease Disease Management Education Educational Curriculum Elements Enrollment Evaluation Evidence based intervention Feedback Focus Groups Food Geography Glycosylated hemoglobin A Goals Guidelines Health Health behavior Health education High Density Lipoprotein Cholesterol Home Hypertension India Intervention Intervention Studies Knowledge LDL Cholesterol Lipoproteins Life Style Life Style Modification Lipids Maintenance Measures Medical center Medication Management Mental Depression Metabolic Methods Modeling Morbidity - disease rate Motivation Non-Insulin-Dependent Diabetes Mellitus Outcome Participant Patient Recruitments Patient-Centered Care Patient-Focused Outcomes Patients Pharmacy facility Physical activity Population Positioning Attribute Poverty Poverty Areas Prevalence Provider Psychological reinforcement Randomized Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Records Reporting Research Risk Role Rural Rural Appalachia Self Management Service delivery model Site Surveys Techniques Testing Triglycerides West Virginia acceptability and feasibility arm base behavior change behavior measurement blood lipid cardiovascular disorder risk community partnership comorbidity cost diabetes distress diabetes educator diabetes self-management econometrics efficacy evaluation eligible participant empowerment evidence base evidence based guidelines experience feasibility testing follow-up health related quality of life health training healthy lifestyle improved intervention effect lifestyle intervention medically underserved medication compliance mortality multimodality nutrition patient oriented pedometer programs psychologic recruit retention rate rural area rural patients satisfaction self-management program skills social social health determinants treatment as usual underserved area usual care arm

项目摘要

West Virginia ranks 1st & 2nd nationally in the prevalence of diabetes and hypertension. Yet many rural patients with comorbid diabetes and hypertension do not receive self-management support from their providers. The goal of this R34 planning project is to test the feasibility and acceptability of a culturally-tailored, multimodal, 6-week modified Diabetes and Hypertension Self-Management Program (M-DHSMP), that will incorporate evidence-based key elements of diet, physical activity and medication adherence (with medication therapy management or MTM). The M-DHSMP is an adaptation of the evidence-based curriculum of the American Association of Diabetes Educator (AADE-7) and the JNC guidelines. Seventy five adults with comorbid diabetes and hypertension will be recruited from the northern counties of West Virginia and randomized with a 1:1:1 ratio. We propose to conduct a 3-arm randomized controlled trial (RCT) to compare the 6-week M-DHSMP core intervention (diet and physical activity; n=25), 6-week M-DHSMP core plus medication adherence with MTM (n=25) or enhanced usual care (EUC); n=25) in two geographically separated Patient Centered Medical Homes (PCMH). We will use post-regression decomposition technique derived from the field of econometrics to examine the extent to which key components (diet, physical activity, and medication adherence) contribute to the differences in clinical outcomes (HbA1c and blood pressure) between groups (M-DHSMP core and M-DHSMP core plus medication adherence). In addition, we will use qualitative focus groups and the RE-AIM evaluation framework to evaluate the reach, efficacy, adoption, sustainability of behavior changes, and participants’ experience and satisfaction with the program. Measures of behavioral changes will include dietary intake, physical activity, medication adherence, using surveys, food /activity logs and prescription filling reports. As in our prior studies, trained Health Coaches (HCs) will administer the program and provide weekly follow-up coaching, review food/activity logs for continuous feedback and reinforcement of health education messages. An understanding of the independent and combined effects of key health behavior components and the role of/adoption of behavior modifications in patients with diabetes and hypertension can validate self-management interventions models in real-world settings to reduce the metabolic risk. The longer term effects of the intervention will be evaluated in a subsequent R01 clinical trial. The project builds on the PI’s successful prior community-based lifestyle intervention studies in rural Appalachia and rural India.

西弗吉尼亚州的糖尿病和高血压患病率在全国排名第一和第二，但仍有许多农村患者。患有糖尿病和高血压的患者无法从其提供者处获得自我管理支持。 R34 规划项目的目标是测试根据文化量身定制的可行性和可接受性，多模式、为期 6 周的改良糖尿病和高血压自我管理计划 (M-DHSMP)，将证据包含饮食、体力活动和药物依从性（药物治疗 M-DHSMP 是循证课程的改编版。美国糖尿病教育者协会 (AADE-7) 和 JNC 指南 75 名成人。将从西弗吉尼亚州北部县招募患有糖尿病和高血压的患者我们建议以 1:1:1 的比例进行随机对照试验 (RCT) 进行比较。 6 周 M-DHSMP 核心干预（饮食和体力活动；n=25），6 周 M-DHSMP 核心加两个地理位置相隔的患者中坚持使用 MTM（n=25）或加强常规护理（EUC）；以患者为中心的医疗之家 (PCMH) 我们将使用源自后回归分解技术。计量经济学领域研究关键组成部分（饮食、体力活动和药物依从性）导致临床结果（HbA1c 和血压）的差异组（M-DHSMP 核心和 M-DHSMP 核心加药物依从性）。此外，我们将使用定性。焦点小组和 RE-AIM 评估框架来评估行为变化以及参与者对计划的体验和满意度。变化将包括饮食摄入量、体力活动、药物依从性、使用调查、食物/活动日志和我们之前的研究一样，训练有素的健康教练 (HC) 将管理这些内容。计划并提供每周后续辅导，审查食物/活动日志以获得持续反馈和强化健康教育信息。糖尿病患者的关键健康行为组成部分以及行为改变的作用/采用高血压可以在现实环境中验证自我管理干预模型，以减少代谢风险。干预的长期效果将在随后的 R01 临床试验中进行评估。该项目建立在 PI 之前在农村地区成功进行的基于社区的生活方式干预研究的基础上阿巴拉契亚和印度农村。