工具箱方法在城市保障网基层医疗诊所中的肥胖治疗应用：一项实用临床试验。
A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial.
机构信息
Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA.
出版信息
J Gen Intern Med. 2019 Nov;34(11):2405-2413. doi: 10.1007/s11606-019-05222-0. Epub 2019 Aug 26.
BACKGROUND
There is a need for new strategies to improve the success of obesity treatment within the primary care setting.
OBJECTIVE
To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care.
DESIGN
Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital.
PARTICIPANTS
From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention.
INTERVENTIONS
Medical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months.
MAIN MEASURES
The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss.
KEY RESULTS
Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes.
CONCLUSIONS
Access to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity.
TRIAL REGISTRATION
背景
需要新策略来提高初级保健环境中肥胖治疗的成功率。
目的
确定为患者提供低自付费用的体重管理工具是否比常规护理更能实现减重。
设计
在城市医疗保障医院的基层医疗诊所进行的为期 12 个月的实用临床减重试验，同时设立基于注册的对照组。
参与者
我们从一个大型临床注册中心随机选择了 428 名患者，为他们提供接受干预的机会。
干预措施
患者只需每月支付 5 或 10 美元，即可获得部分代餐、娱乐中心优惠券、药物治疗、商业减重计划优惠券和团体行为减重计划等医疗减重工具。患者可以选择自己的工具，可以随时更换工具，也可以在 6 个月后添加第二种工具。
主要观察指标
主要结局是符合干预条件的患者中体重减轻≥5%的比例。主要次要结局是治疗中患者体重减轻≥5%的比例。
结果
总体而言，428 名患者中共有 71.3%（305 名）有可用的体重测量数据/PCP 就诊数据来观察主要结局。在 12 个月时，符合干预条件的参与者中有 23.3%（71 名）和基于注册的对照组中有 15.7%（415 名）体重减轻≥5%（p<0.001）。在治疗中的患者中，34.5%（39 名）体重减轻≥5%。治疗中的患者体重平均减轻-3.15%±6.41%，而对照组为-0.30%±6.10%（p<0.001）。最初首选的工具是代餐、药物治疗和娱乐中心通行证。
结论
在初级保健中提供多种低自付费用的体重管理工具，使大约四分之一的低收入肥胖患者体重减轻≥5%。
Zotero 插件