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Al‐Omar HA, Czech M, Quang Nam T, Gottwald‐Hostalek U, Vesic N, Whitehouse J, Dawson M. Cost saving analysis of prediabetes intervention modalities in comparison with inaction using Markov state transition model-A multiregional case study. J Diabetes 2024; 16:e13553. [PMID: 38664882 PMCID: PMC11045917 DOI: 10.1111/1753-0407.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 02/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Prediabetes management is a priority for policymakers globally, to avoid/delay type 2 diabetes (T2D) and reduce severe, costly health consequences. Countries moving from low to middle income are most at risk from the T2D "epidemic" and may find implementing preventative measures challenging; yet prevention has largely been evaluated in developed countries. METHODS Markov cohort simulations explored costs and benefits of various prediabetes management approaches, expressed as "savings" to the public health care system, for three countries with high prediabetes prevalence and contrasting economic status (Poland, Saudi Arabia, Vietnam). Two scenarios were compared up to 15 y: "inaction" (no prediabetes intervention) and "intervention" with metformin extended release (ER), intensive lifestyle change (ILC), ILC with metformin (ER), or ILC with metformin (ER) "titration." RESULTS T2D was the highest-cost health state at all time horizons due to resource use, and inaction produced the highest T2D costs, ranging from 9% to 34% of total health care resource costs. All interventions reduced T2D versus inaction, the most effective being ILC + metformin (ER) "titration" (39% reduction at 5 y). Metformin (ER) was the only strategy that produced net saving across the time horizon; however, relative total health care system costs of other interventions vs inaction declined over time up to 15 y. Viet Nam was most sensitive to cost and parameter changes via a one-way sensitivity analysis. CONCLUSIONS Metformin (ER) and lifestyle interventions for prediabetes offer promise for reducing T2D incidence. Metformin (ER) could reduce T2D patient numbers and health care costs, given concerns regarding adherence in the context of funding/reimbursement challenges for lifestyle interventions.
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Affiliation(s)
- Hussain Abdulrahman Al‐Omar
- Department of Clinical PharmacyCollege of Pharmacy, King Saud UniversityRiyadhSaudi Arabia
- Health Technology Assessment Unit (HTAU)College of Pharmacy, King Saud UniversityRiyadhSaudi Arabia
| | - Marcin Czech
- Pharmacoeconomic DepartmentInstitute of Mother and ChildWarsawPoland
| | - Tran Quang Nam
- Department of EndocrinologyUniversity Medical CenterHo Chi Minh CityVietnam
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Albert SL, Massar RE, Kwok L, Correa L, Polito-Moller K, Joshi S, Shah S, McMacken M. Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation. Am J Lifestyle Med 2024; 18:403-419. [PMID: 38737881 PMCID: PMC11082870 DOI: 10.1177/15598276221113507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants' main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.
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Affiliation(s)
- Stephanie L. Albert
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Rachel E. Massar
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lorraine Kwok
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lilian Correa
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Krisann Polito-Moller
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Shivam Joshi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Sapana Shah
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Michelle McMacken
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
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Ames ML, Karlsen MC, Sundermeir SM, Durrwachter N, Hemmingson TA, Reznar MM, Staffier KL, Weeks B, Gittelsohn J. Lifestyle Medicine Implementation in 8 Health Systems: Protocol for a Multiple Case Study Investigation. JMIR Res Protoc 2024; 13:e51562. [PMID: 38320320 DOI: 10.2196/51562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. OBJECTIVE This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. METHODS The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. RESULTS The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. CONCLUSIONS This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51562.
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Affiliation(s)
- Meghan L Ames
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Micaela C Karlsen
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Samantha M Sundermeir
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Neve Durrwachter
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Melissa M Reznar
- School of Health Sciences, Oakland University, Rochester, MI, United States
| | | | - Bruce Weeks
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Joel Gittelsohn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Distler KR, Lindsey MJ, Mims MH, Taylor MA, Hollingsworth JC. Primary Care Clinic Approaches to Facilitating Patient Health Behavior Change in Alabama. Cureus 2024; 16:e55973. [PMID: 38601414 PMCID: PMC11006427 DOI: 10.7759/cureus.55973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Non-communicable chronic diseases (NCCDs), such as cardiovascular disease, diabetes, and cancer, are the leading cause of death and disability and the leading driver of healthcare costs in the U.S. It is estimated that 80% of chronic diseases and premature deaths are attributable to modifiable lifestyle factors related to smoking and alcohol intake, poor eating patterns, and physical inactivity. Inadequate sleep also plays a significant role. Among other directives, primary care providers (PCPs) have the opportunity to contribute to preventing and treating NCCD in their patients. Comprehensive, evidence-based behavioral counseling interventions are recommended to PCPs as a first-line approach to improving outcomes. However, presumably due to a lack of PCP time, training or resources, most patients report not receiving such services. Currently, the extent to which PCPs in Alabama offer or refer patients to health behavior change (HBC) services is unknown. Objectives This study aims to assess the following: (1) Alabama PCPs' current approaches in facilitating patient HBC in the domains of eating patterns, physical activity, sleep, and stress and (2) the likelihood of the Alabama PCPs referring patients to virtual HBC programs, once developed by an osteopathic medical school in the state. Methods Data were collected from clinic personnel who were knowledgeable regarding the clinic's approach to facilitating patient HBC via scripted telephone interviews and online surveys sent via email. The clinic list utilized for the study was derived from a list of VCOM-Auburn clinical preceptors. Primary care and specialty clinics were included. Data were analyzed descriptively to determine the number of clinics that (1) provide, recommend, or refer programs, services, or resources to patients to facilitate HBC related to eating patterns, physical activity, sleep, and stress management and (2) are likely to refer patients to free virtual HBC programs, once developed by an osteopathic medical school in the state. Results Of the 198 clinics that were contacted, 75 were excluded, 46 were "no response," 53 agreed to participate, and 50 completed the survey. Of the 50 clinics that completed the survey, 33 indicated offering resources or referrals for diet, 29 stated they offered resources or referral services for physical activity, 33 indicated offering resources or referrals for sleep, and 28 indicated offering or recommending resources for stress management to patients. Most of the clinics (29/50) felt that their patients would benefit most from a program that facilitates improvement in eating patterns, and 41/50 clinics said that they are either "somewhat" or "extremely" likely to refer patients to a free VCOM-Auburn HBC program, once available. Conclusions Findings indicate that a significant percentage of PCP clinics are not offering HBC resources to patients and that most PCP clinics would consider referring patients to free VCOM-Auburn HBC programs, once available. Phone data were significantly different from email data. The primary limitations were a low response rate and potential response bias.
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Affiliation(s)
- Kyle R Distler
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Marla Jo Lindsey
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Hinson Mims
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Ann Taylor
- Psychiatry and Neuro-behavioral Sciences, Center for Institutional, Faculty, and Student Success, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
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Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, Brown ML, Dwivedi ME, Ezinwa NM, Kelly JH, Mechley AR, Miller LA, Misquitta RK, Parkinson MD, Patel D, Patel PM, Studer KR, Karlsen MC. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care. Am J Lifestyle Med 2024; 18:269-293. [PMID: 38559790 PMCID: PMC10979727 DOI: 10.1177/15598276231202970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes. METHODS Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus. RESULTS The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education. CONCLUSION The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.
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Affiliation(s)
- Meagan L. Grega
- St. Luke's University Health Network, Easton, PA, USA; Kellyn Foundation, Tatamy, PA, USA (MLG)
| | - Jennifer T. Shalz
- Lifestyle Medicine Department, St. Luke’s Health System, Boise ID, USA (JTS)
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Science University, Brooklyn, NY, USA (RMR)
| | - Josie H. Bidwell
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MI, USA (JHB)
| | - Jonathan P. Bonnet
- Palo Alto VA Health Care, Palo Alto, CA, USA; Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA (JPB)
| | - David Bowman
- Department of Pediatrics, Howard University College of Medicine, Washington, DC, USA; Lifestyle Med Revolution, LLC, Upper Marlboro, MD, USA (DB)
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (MLB)
| | - Mollie E. Dwivedi
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University Living Well Center, St. Louis, MO, USA (MED)
| | | | - John H. Kelly
- Loma Linda University, Loma Linda, CA, USA; Lifestyle Health Education Inc., Rocky Mount, VA, USA (JHK)
| | - Amy R. Mechley
- University of Cincinnati College of Medicine, Cincinnati, OH, USA (ARM)
| | - Lawrence A. Miller
- Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA (LAM)
| | - Rajiv K. Misquitta
- Department of Lifestyle Medicine, The Permanente Medical Group, Sacramento, CA, USA (RKM)
| | | | - Dipak Patel
- Community Health Center, Inc., Meriden, CT, USA; Connecticut Lifestyle Medicine, CT, USA (DP)Community Health Center, Inc., Middletown, CT, USA (DP)
| | - Padmaja M. Patel
- Lifestyle Medicine Center, Midland Health, Midland, TX, USA (PMP)
| | - Karen R. Studer
- Preventive Medicine, Loma Linda University Health, Loma Linda, CA, USA (KRS)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO, USA; Departments of Applied Nutrition and Global Public Health, University of New England, Biddeford, ME, USA (MCK)
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Knecht AS, Akolkar N, Molinari AH, Palma ML. Community Medicine, Community Health, and Global Health: Interdisciplinary Fields With a Future Lens Inclusive of Local and Global Health Equity. AJPM FOCUS 2024; 3:100165. [PMID: 38130804 PMCID: PMC10733686 DOI: 10.1016/j.focus.2023.100165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
| | - Namita Akolkar
- Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Alexander H.W. Molinari
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melissa L. Palma
- Department of Family Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Hoffman RM. General health warnings about ultra-processed foods are not enough. BMJ 2023; 383:2609. [PMID: 37945048 DOI: 10.1136/bmj.p2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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Pollard KJ, Gittelsohn J, Patel P, Lianov L, Freeman K, Staffier KL, Pauly KR, Karlsen MC. Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout. Am J Health Promot 2023; 37:1121-1132. [PMID: 37368959 PMCID: PMC10631282 DOI: 10.1177/08901171231182875] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING Web-based survey platform. PARTICIPANTS Members of an LM medical professional society at the time of survey administration. METHODS Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.
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Affiliation(s)
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Liana Lianov
- Global Positive Health Institute, Sacramento, CA, USA
| | - Kelly Freeman
- American College of Lifestyle Medicine, Chesterfield, MO, USA
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Ackermann RT, Cameron KA, Liss DT, Dolan N, Aikman C, Carson A, Harris SA, Doyle K, Cooper AJ, Hitsman B. Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic practice components and results of a randomized feasibility trial. RESEARCH SQUARE 2023:rs.3.rs-3074046. [PMID: 37547026 PMCID: PMC10402202 DOI: 10.21203/rs.3.rs-3074046/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health systems face challenges implementing them. We engaged stakeholders to cocreate and evaluate feasibility of primary care implementation strategies and of a pragmatic randomization procedure to be used for a future effectiveness trial. Methods The study setting was a single, urban primary care office. Patients with BMI ≥ 27 and ≥ 1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support an initial weight loss goal of about 10 pounds in 10 weeks. All patients who affirmed weight loss interest were pragmatically enrolled in the trial and offered "Basic Lifestyle Services" (BLS), including a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of these resources. About half (n = 42) of participants were randomized by an automated EHR algorithm to also receive "Customized Lifestyle Services" (CLS), including weekly email messages adapted to individual weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned January to July 2020, with interference by the coronavirus pandemic. Weight measures were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed acceptability, appropriateness, and sustainability of intervention components. Results Over 6 weeks, 426 patients were sent the EHR invitation message and 80 (18.8%) affirmed interest in the weight loss goal and were included for analysis. EHR data were available to ascertain a 6-month weight value for 77 (96%) patients. Overall, 62% of participants lost weight; 15.0% exhibited weight loss ≥ 5%, with no statistically significant difference between CLS or BLS arms (p = 0.85). CLS assignment increased participation in daily self-weighing (43% versus 21% of patients through 12 weeks) and enrollment in referral-based lifestyle support resources (52% versus 37%). Conclusions This preliminary study demonstrates feasibility of implementation strategies for primary care offices to offer and coordinate ILI core components, as well as a pragmatic randomization procedure for use in a future randomized comparative trial.
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