Schultz Courtney L, Bocarro Jason N, Hipp J Aaron, Bennett Gary J, Floyd Myron F
Health & Technology Partners, Milwaukee, WI, United States.
Department of Parks, Recreation & Tourism Management, College of Natural Resources, NC State University, Raleigh, NC, United States.
Front Digit Health. 2022 Jul 19;4:932533. doi: 10.3389/fdgth.2022.932533. eCollection 2022.
eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients.
The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes ( = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate.
The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes.
电子健康技术提供了一种有效的方法，使初级卫生保健（PHC）提供者能够将公园处方纳入临床实践，以帮助患者通过量身定制的、基于自然的健康行为干预措施改善健康状况。本文描述了目标处方干预（GPI）的方案，该方案旨在利用社区资源为初级卫生保健患者提供量身定制的公园处方。
GPI研究设计为一项三臂、多地点观察性研究。我们从美国北卡罗来纳州两个县的联邦合格健康中心（FQHC）招募了75名有高血压或糖尿病风险或患有高血压或糖尿病的低收入农村成年人，进行为期3个月的干预。符合条件的参与者自行选择接受：（1）量身定制的公园处方干预；（2）量身定制的家庭/室内身体活动处方干预；或（3）健康饮食处方（除初级卫生保健中常规提供标准身体活动咨询建议外，无身体活动处方）作为对照组。GPI应用程序将电子健康记录中的患者健康数据与患者陈述的偏好进行配对，并直接向患者触发应用程序集成的短信激励和依从性信息。在基线时以及干预完成后的3个月随访时对患者进行评估。在3个月时评估主要结局（通过Fitbit Flex 2测量，从基线（T0）到干预后（T1）每周身体活动的平均差异）。次要结局包括评估干预与健康生物标志物之间的关系，包括体重指数（BMI）、收缩压和舒张压、糖化血红蛋白或可用血糖测试（如适用），以及使用患者健康问卷9进行的抑郁筛查评分。次要结局还包括发送的短信总数、回复的短信数量（原文有误，应为“回复的短信数量”）、忽略的短信数量和退出率。
目标是创建一个利用电子健康技术的方案，该方案满足农村低收入社区的特定需求，并符合北卡罗来纳州选定的联邦合格健康中心诊所的自然节奏和流程。该方案通过将患者与其初级卫生保健团队联系起来，并提高患者做出更持久健康行为改变的动机，提供了更高标准的医疗保健。
