Background: Nearly 20 percent of the US population lives in rural communities. Rural residents suffer disproportionally from obesity and have less access to effective weight loss programs. Primary care offices have the potential to fill an important need in treating obesity in rural America. Primary care is traditionally provided on a fee-for-service model with 15-minute office visits. Two new approaches for managing chronic diseases in primary care are the patient-centered medical home (PCMH) and disease management (DM). Both PCMH and DM approaches offer coordinated delivery of services that extend beyond the limitations of a face-to-face office visit. With the PCMH model, services are provided within the primary care practice; whereas with DM, services are provided by a centralized counselor by telephone. Both PCMH and DM approaches allow professionals with more specific training in weight loss counseling to provide care and offer enhanced patient access with after-hours group visits, phone visits, and email/text message support.
Objectives: This study will compare PCMH and DM to the traditional fee-for-service model for treating obesity in rural primary care practices in the midwestern United States.
Methods: Thirty-six practices located in Kansas, Nebraska, Wisconsin, and Iowa will be randomized to one of the three treatment approaches.
Patient Outcomes: The primary outcome is weight loss at 24 months. Weight loss is both the goal of clinical guidelines and highly important to patients. Other outcomes important to patients include laboratory measures, quality of life, sleep quality, and levels of stress.
Patient and Stakeholder Engagement: Our Patient Advisory Panel has shaped the treatment approaches and participant characteristics, and it has defined outcomes that are important to patients. We also have engaged local, state, and national stakeholders, including rural primary care providers, insurers, the American Academy of Family Physicians, the National Committee for Quality Assurance, and state health departments. Our engagement plan includes an in-person, daylong meeting at the outset of the study with all patient partners, stakeholders, and investigators where we will make our patient-centered approach the foundation for implementing the study, communicate the roles of each group, and establish consensus building as the decision-making approach. Ongoing patient engagement will occur through regular meetings, progress reports, and an in-person dissemination planning meeting to share lessons learned and develop messages and vehicles for disseminating the study findings.
Anticipated Impact: The results have the potential to immediately influence how obesity is treated in rural primary care offices. The treatment approaches tested in this study meet the needs of rural patients, could easily be adopted by other physicians, and have potential to affect payment policies, treatment guidelines, and training of practitioners.
Befort CA, VanWormer JJ, DeSouza C, et al. Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care, Contemporary Clinical Trials (March 2016).