Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care (Pennsylvania)

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Summary:

The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to those who are obese to promote sustained weight loss. Despite this guideline, fewer than half of physicians provide such counseling due to a lack of training, cost, and time constraints.

This study looked at the use of health information technology to facilitate clinical lifestyle counseling on weight loss, with the goal of integrating lifestyle issues into routine preventive medicine. The team looked at the effectiveness of delivering an online version of the Diabetes Prevention Program (DPP) intensive lifestyle curriculum. The DPP includes counseling on diet, physical activity, and behavior modification. DPP has been shown to be efficacious for promoting weight loss, and has led to improvements in diabetes- and weight-related co-morbidities. Automating the counseling process and delivering it via the Internet may reduce staffing costs and increase patient convenience.

The specific aims of this project were to:

  • Use Internet technology to translate an evidence-based lifestyle intervention into diverse primary care settings in order to facilitate the delivery of evidence-based preventive counseling.
  • Examine how different strategies of delivering a DPP-based online lifestyle intervention differ in weight loss and cost-effectiveness.

Obese primary care patients were enrolled in one of three randomized controlled trial arms. All participants received a lifestyle intervention consisting of an in-person lifestyle counseling session plus 1 year of access to one of the following: a comprehensive online intervention modelled on DPP with standard coaching (COI-S); a comprehensive online intervention modelled on DPP with modulated coaching (COI-M) in which coaching was provided only when a need was identified or; online lifestyle goals and resources without coaching (OGR). Coaches had access to an electronic tool that helped them identify participants in the COI-M group who were not meeting program goals and thus needed coaching sessions.

Patients in all three arms of the study lost weight at 6 months. Although there was not a statistically significant difference between the groups, point estimates suggested that the COI-S intervention had a greater clinically significant impact. At 12 months, weight loss was sustained in all study arms, with point estimates for weight further declining in the COI-M and OGR arms during the second half of the interventions. At each time point, there was no significant difference in weight loss between groups.

This research showed that online lifestyle support can be a more efficacious obesity intervention than a typical primary care visit.

Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018155
  • Project Period: 
    October 2009 – July 2013
  • AHRQ Funding Amount: 
    $1,199,824
  • PDF Version: 
    (PDF, 235.63 KB)

Summary: Because obesity is a major cause of cardiovascular disease, the United States Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for those who are obese.

This study is looking at using health information technology to enable clinical lifestyle counseling on weight loss, with the goal of integrating lifestyle issues into routine preventive medicine. The research is examining the effectiveness of delivering an online version of the Diabetes Prevention Program (DPP) lifestyle intervention in a primary care setting. Recruitment targeted a group of participants who vary in terms of gender, body mass index, comorbidity status, race, and ethnicity. The coaching strategies incorporate physician feedback. Assessment of the intervention includes looking at multiple outcomes, including change in weight, waist circumference, physical activity, quality of life, and intervention cost- effectiveness. Furthermore, the use of technology may provide a more patient-centered approach to clinical obesity management.

This research seeks to address the key problem of how to implement USPSTF obesity screening and treatment recommendations in a cost-effective manner and to help translate well-established methods into a clinical setting.

Specific Aims: 

  • Use Internet technology to translate an evidence-based lifestyle intervention into diverse primary care settings in order to facilitate the delivery of evidence-based preventive counseling. (Ongoing)
  • Examine how different strategies of delivering a DPP-based online lifestyle intervention differ in weight loss and cost-effectiveness. (Ongoing)

2012 Activities: Activities focused on integrating the online lifestyle intervention into routine primary care delivery at all participating sites and collecting outcomes data for a large portion of participants. The study team gathered data for the primary outcome (body weight change) in 272 of the 377 participants (72.1 percent) with a very narrow data collection window of 1 year +/- 2 weeks. The data analysis window is 1 year +/- 30 days. The project team abstracted program use data manually from the online intervention software, while time-use data for the cost-effectiveness analysis was extracted digitally by the software vendor. The initial data analysis has been completed and the team is formulating a plan for manuscript development. Development of the cost-effectiveness model is also in progress. Throughout the year, the project team met with the software vendor on a regular basis to resolve minor technical issues, identify potential software enhancements, and increase quality assurance mechanisms.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and the project budget funds are moderately underspent due to some changes in key project staff in 2012. The project team is using a 10-month no-cost extension to complete the scope of activities.

Preliminary Impact and Findings: Informal feedback from physicians at the participating sites suggests there is interest in access to an online weight-maintenance intervention.

Target Population: Adults, Obesity Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018155
  • Project Period: 
    October 2009 - September 2012
  • AHRQ Funding Amount: 
    $1,199,824
  • PDF Version: 
    (PDF, 181.54 KB)

Summary: Because obesity is a major cause of cardiovascular disease, the United States Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for those who are obese.

This study is looking at using health information technology to enable clinical lifestyle counseling on weight loss with the goal of integrating lifestyle issues into routine preventive medicine. The research is examining the effectiveness of delivering an online version of the Diabetes Prevention Program (DPP) lifestyle intervention in a primary care setting. Recruitment targeted a group of participants who vary in terms of gender, body mass index, comorbidity status, race, and ethnicity. The coaching strategies incorporate physician feedback. Assessment of the intervention looks at multiple outcomes, including change in weight, waist circumference, physical activity, quality of life, and intervention cost-effectiveness.

This research seeks to address the key problem of how to implement USPSTF obesity screening and treatment recommendations in a cost-effective manner and help translate well-established methods into a clinical setting. Furthermore, the use of technology may provide a more patient-centered approach to clinical obesity management.

Specific Aims:

  • Use Internet technology to translate an evidence-based lifestyle intervention into diverse primary care settings in order to facilitate the delivery of evidence-based preventive counseling. (Ongoing)
  • Examine how different strategies of delivering a DPP-based online lifestyle intervention differ in weight loss and cost-effectiveness. (Ongoing)

2011 Activities: The focus of activity was on the lifestyle coaches' 6- and 12-month face-to-face "outcome visits" with study participants. By December, all 12-month follow-up visits were completed. Throughout the year the project team implemented several new strategies to help increase participant compliance in completing their visits. Strategies included increasing the financial incentive from $25.00 to $40.00 and adding more ways to engage with participants, such as sending greeting cards. The strategies resulted in greater participation in the 12-month visits compared to the 6-month visit completion rate. Preliminary data analysis began in 2011 and more in-depth analysis will continue into 2012.

The project team also continued to meet with the software vendor on a regular basis to resolve minor technical issues, identify potential software enhancements, and increase quality assurance mechanisms. One technical enhancement made this year was to grant remote access to one of the life coaches who moved out of state, which allowed the coach to stay on as part of the project team and preventing the need to hire any new staff.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and the project budget is moderately underspent. Spending began to increase once the project team became fully staffed and the project team anticipates that spending will be on track for the remainder of the project.

Preliminary Impact and Findings: There are no findings to report as data collection is still in progress. Informal feedback from physicians at the participating sites suggests there is interest in access to an online weight-maintenance intervention.

Target Population: Adults, Obesity

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Online Counseling to Enable Lifestyle-focused Obesity Treatment in Primary Care - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018155
  • Project Period: 
    October 2009 – September 2012
  • AHRQ Funding Amount: 
    $1,199,824
  • PDF Version: 
    (PDF, 341.1 KB)


Target Population: Adults, Obesity

Summary: Obesity is a major cause of cardiovascular disease. More than half of the United States population is estimated to be overweight and an estimated 31 percent are obese. While the United States Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for those who are obese, there are multiple barriers to intensive lifestyle counseling and the recommendation has not been widely implemented.

This study looks at using health information technology to enable clinical lifestyle counseling on weight loss with the goal of integrating lifestyle issues into routine preventive medicine. The research examines the effectiveness of delivering an online version of the Diabetes Prevention Program (DPP) lifestyle intervention in a primary care setting. Recruitment is targeted to a diverse group of participants in terms of gender, body mass index, comorbidity status, and racial, ethnic mix. The coaching strategies incorporate physician feedback. Assessment of the intervention looks at multiple outcomes, including change in weight, waist circumference, physical activity, quality of life, and intervention cost-effectiveness.

The study seeks to address the key problem of how to implement USPSTF obesity screening and treatment recommendations in a cost-effective manner and help translate well-established methods into a clinical setting. Furthermore, the use of technology may provide a more patient-centered approach to clinical obesity management.

Specific Aims:
  • Use Internet technology to translate an evidence-based lifestyle intervention into diverse primary care settings in order to facilitate the delivery of evidence-based preventive counseling. (Ongoing)
  • Examine how different strategies of delivering a DPP-based online lifestyle intervention differ in weight loss and cost-effectiveness. (Ongoing)

2010 Activities: Study participant recruitment began and included hiring and training staff, ordering supplies, developing and printing advertising materials, securing space for orientation sessions, and creating an electronic referral form. The rate of general recruitment is on target and the recruitment of minorities in particular has exceeded the target of 15 percent. Development of the study database was completed and the database was implemented, as was a new protocol for the virtual lifestyle management online lifestyle coaching strategy. The project team continues to meet with the software vendor on a regular basis to resolve technical issues, identify potential software enhancements, and increase quality assurance mechanisms. One enhancement made in 2010 was to make archiving of the coaches’ notes more user-friendly, which has proven extremely useful when one coach is on vacation and another coach is filling in. The final participant sites were added in October, bringing the number of participating sites to six. The lifestyle coaches have begun to conduct face-to-face “outcome visits” with participants and data from those visits will soon be available for preliminary analysis.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Dr. McTigue reports that aims and milestones are mostly on track. The budget is currently underspent but the rate of spending will increase with ongoing data collection and upcoming data analysis.

Preliminary Impact and Findings: There are no findings to report as data collection is still in progress. Informal feedback from physicians at the participating sites suggests there is interest in access to an online weight-maintenance intervention.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care - Final Report

Citation:
McTigue, K. M. Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care - Final report. (Prepared by the University of Pittsburgh under Grant No. R18 HS018155). Rockville, MD: Agency for Healthcare Research and Quality, 2013. (PDF, 629.28 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
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