Viglione Clare, Bouwman Dylaney, Rahman Nadera, Fang Yixin, Beasley Jeannette M, Sherman Scott, Pi-Sunyer Xavier, Wylie-Rosett Judith, Tenner Craig, Jay Melanie
1Veteran Affairs New York Harbor Healthcare System & NYU School of Medicine, New York, USA.
2NYU School of Medicine & Veteran Affairs New York Harbor Healthcare System, New York, USA.
BMC Obes. 2019 Feb 4;6:4. doi: 10.1186/s40608-018-0226-0. eCollection 2019.
Goals for Eating and Moving (GEM) is a technology-assisted health coaching intervention to improve weight management in primary care at the Veterans Health Administration (VHA) that we designed through prior rigorous formative studies. GEM is integrated within the patient-centered medical home and utilizes student health coach volunteers to counsel patients and encourage participation in VHA's intensive weight management program, MOVE!. The primary aim of this study was to determine the feasibility and acceptability of GEM when compared to Enhanced Usual Care (EUC). Our secondary aim was to test the impact of GEM on weight, diet and physical activity when compared to EUC.
Veterans with a Body Mass Index ≥30 kg/m or 25-29.9 kg/m with comorbidities ( = 45) were recruited in two phases and randomized to GEM ( = 22) or EUC ( = 23). We collected process measures (e.g. number of coaching calls completed, number and types of lifestyle goals, counseling documentation) and qualitative feedback on quality of counseling and acceptability of call duration. We also measured weight and behavioral outcomes.
GEM participants reported receiving high quality counseling from health coaches and that call duration and frequency were acceptable. They received 5.9 (SD = 3.7) of 12 coaching calls on average, and number of coaching calls completed was associated with greater weight loss at 6-months in GEM participants (Spearman Coefficient = 0.71, < 0.001). Four participants from GEM and two from EUC attended the MOVE! program. PCPs completed clinical reminders in 12% of PCP visits with GEM participants. Trends show that GEM participants ( = 21) tended to lose more weight at 3-, 6-, and 12-months as compared to EUC, but this was not statistically significant. There were no significant differences in diet or physical activity.
We found that a technology assisted health coaching intervention delivered within primary care using student health coaches was feasible and acceptable to Veteran patients. This pilot study helped elucidate challenges such as low provider engagement, difficulties with health coach continuity, and low patient attendance in MOVE! which we have addressed and plan to test in future studies.
NCT03006328 Retrospectively registered on December 30, 2016.
饮食与运动目标（GEM）是一种通过技术辅助的健康指导干预措施，旨在改善退伍军人健康管理局（VHA）初级保健中的体重管理，这是我们通过先前严格的形成性研究设计的。GEM整合在以患者为中心的医疗之家内，并利用学生健康教练志愿者为患者提供咨询，并鼓励他们参与VHA的强化体重管理计划“行动！”。本研究的主要目的是确定与强化常规护理（EUC）相比，GEM的可行性和可接受性。我们的次要目的是测试与EUC相比，GEM对体重、饮食和身体活动的影响。
招募体重指数（BMI）≥30kg/m²或25 - 29.9kg/m²且患有合并症的退伍军人（n = 45），分两个阶段进行，并随机分为GEM组（n = 22）或EUC组（n = 23）。我们收集了过程指标（如完成的指导电话数量、生活方式目标的数量和类型、咨询记录）以及关于咨询质量和通话时长可接受性的定性反馈。我们还测量了体重和行为结果。
GEM参与者报告称从健康教练那里获得了高质量的咨询，并且通话时长和频率是可以接受的。他们平均接受了12次指导电话中的5.9次（标准差 = 3.7），在GEM参与者中，完成的指导电话数量与6个月时更大的体重减轻相关（斯皮尔曼系数 = 0.71，P < 0.001）。GEM组有4名参与者和EUC组有2名参与者参加了“行动！”计划。在与GEM参与者的初级保健医生（PCP）就诊中，PCP完成临床提醒的比例为12%。趋势表明，与EUC组相比，GEM组（n = 21）在3个月、6个月和12个月时往往体重减轻更多，但这在统计学上并不显著。在饮食或身体活动方面没有显著差异。
我们发现，在初级保健中使用学生健康教练进行的技术辅助健康指导干预对退伍军人患者来说是可行且可接受的。这项试点研究有助于阐明一些挑战，如提供者参与度低、健康教练连续性困难以及“行动！”计划中患者参与率低等问题，我们已经解决了这些问题，并计划在未来的研究中进行测试。
NCT03006328，于2016年12月30日进行回顾性注册。
