title: Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care.
abstract: Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N=1440) age 20 to 75 with a BMI 30-45 kg/m(2). In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care.
authors.affiliation: University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, 66160, United States. Electronic address: cbefort@kumc.edu.
authors.forename: Christie A
authors.initials: CA
authors.lastname: Befort
authors.affiliation: Marshfield Clinic Research Foundation, Center for Clinical Epidemiology and Population Health, Marshfield, WI 54449, United States. Electronic address: vanwormer.jeffrey@mcrf.mfldclin.edu.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: VanWormer
authors.affiliation: University of Nebraska Medical Center, Division of Endocrinology, Omaha, NE 68198, United States. Electronic address: cdesouza@unmc.edu.
authors.forename: Cyrus
authors.initials: C
authors.lastname: DeSouza
authors.affiliation: University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, 66160, United States. Electronic address: eellerbe@kumc.edu.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.affiliation: University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, 66160, United States. Electronic address: kkimmina@kumc.edu.
authors.forename: Kim S
authors.initials: KS
authors.lastname: Kimminau
authors.affiliation: University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, 66160, United States. Electronic address: agreiner@kumc.edu.
authors.forename: Allen
authors.initials: A
authors.lastname: Greiner
authors.affiliation: University of Kansas Medical Center, Department of Biostatistics, Kansas City, KS, 66160, United States. Electronic address: bgajewski@kumc.edu.
authors.forename: Byron
authors.initials: B
authors.lastname: Gajewski
authors.affiliation: CUNY School of Public Health, New York, NY 10016, United States. Electronic address: terry.huang@sph.cuny.edu.
authors.forename: Terry
authors.initials: T
authors.lastname: Huang
authors.affiliation: University of Florida, College of Public Health and Health Professions, PO Box 100185, Gainesville, FL 32610, United States. Electronic address: mperri@phhp.ufl.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Perri
authors.affiliation: University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, 66160, United States.
authors.forename: Tera L
authors.initials: TL
authors.lastname: Fazzino
authors.affiliation: University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, 66160, United States. Electronic address: dchristifano@kumc.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Christifano
authors.affiliation: University of Nebraska Medical Center, Division of Endocrinology, Omaha, NE 68198, United States. Electronic address: leslie.eiland@unmc.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Eiland
authors.affiliation: University of Nebraska Medical Center, Division of Endocrinology, Omaha, NE 68198, United States. Electronic address: andjela.drincic@unmc.edu.
authors.forename: Andjela
authors.initials: A
authors.lastname: Drincic
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D002985:Clinical Protocols; D003376:Counseling / Q000379:methods; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D009765:Obesity / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods*; D019035:Rural Health Services; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*
keywords: Behavioral weight loss; Lifestyle intervention; Obesity; Primary care; Rural