Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care

Christie A. Befort, Jeffrey J. VanWormer, Cyrus DeSouza, Edward F. Ellerbeck, Kim S. Kimminau, Allen Greiner, Byron Gajewski, Terry Huang, Michael G. Perri, Tera L. Fazzino, Danielle Christifano, Leslie Eiland, Andjela Drincic

Research output: Contribution to journalArticle

6 Scopus citations

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/m2. 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.

Original languageEnglish (US)
Pages (from-to)304-314
Number of pages11
JournalContemporary Clinical Trials
Volume47
DOIs
StatePublished - Mar 1 2016

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Keywords

  • Behavioral weight loss
  • Lifestyle intervention
  • Obesity
  • Primary care
  • Rural

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Befort, C. A., VanWormer, J. J., DeSouza, C., Ellerbeck, E. F., Kimminau, K. S., Greiner, A., Gajewski, B., Huang, T., Perri, M. G., Fazzino, T. L., Christifano, D., Eiland, L., & Drincic, A. (2016). 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, 47, 304-314. https://doi.org/10.1016/j.cct.2016.02.006