Baseline reach and adoption characteristics in a randomized controlled trial of two weight loss interventions translated into primary care: A structured report of real-world applicability

Abstract

Background Although the Diabetes Prevention Program (DPP) lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults at academic centers, it requires translation into typical primary care settings. Using baseline data from the Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) randomized controlled trial, we evaluated the potential of its two DPP-based interventions to reach their target populations and be adopted into routine use. Methods Overweight/obese adults with increased cardiometabolic risk enrolled from one primary care clinic. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model, we assessed reach with data on patient identification, participation, and representativeness, and adoption with data on intervention feasibility and potential for organizational diffusion. Results The target population was identified by searching electronic health records. Contact was attempted for 2391 patients who completed initial screening by phone (56% uptake) or online (44%). Most (88%) of those screened ineligible were not within the target population; 12% were excluded because of research requirements. Conservatively estimated participation rate was 44%. Participants (n=241) included 54% men and had a mean (SD) age of 52.9 years (10.6) and body mass index of 32 kg/m2 (5.4). Regarding adoption, all clinic physicians agreed to participate. The feasibility of intervention implementation and dissemination was enhanced by leveraging existing intervention, training, and primary care resources. Conclusions E-LITE's lifestyle interventions had fair-to-good potential for primary care reach and adoption. Our trial evidence and structured reporting may inform real-world implementation of translational trials by health networks, physicians, and payers.

Diabetes prevention program in a Mediterranean environment: Individual or group therapy? An effectiveness evaluation

“…In order to achieve widespread dissemination through primary care practice, interventions such as the DPP need to be delivered in more cost-effective formats. These may include formats that are group-based or take advantage of information technologies or both [20]. Recently, the American DPP was revised for community group-based intervention [21,22], suggesting promising results in 1-year outcomes and in sustained weight loss.…”

A review of diabetes prevention program translations: use of cultural adaptation and implementation research

“…• Several mentioned issues around staffing and/or space [60,63,80,83,85,88,90,98,99] Sustainability • Described how the cost was offset (either by the way the program was designed, new insurance policy, or acquisition of a community grant) to integrate the program into usual care…”

“…15 (39 %) [60,62,63,82,83,85,86,88,[90][91][92][93][97][98][99] Other • Unintended increase in Bible study attendance because after group meetings • Discovered a need for tailoring to populations with higher prevalence of mental illness/eating disorders • Discovered health issues with the peer wellness coaches and created a group for them 4 (11 %) [63,85,90,99] SYSTEMATIC REVIEW (to enhance implementation and cultural adaptation). Further, researchers, program developers, and practitioners are employing a number of strategies to enhance translation of the program and reduce costs (e.g., reducing the frequency of classes, trimming the toolkit).…”

Obesity in the US: what is the best role for primary care?

“…• Follow-up less than six months [36][37][38][39] • Studies were solely reports of study design and rationale [40][41][42][43][44][45][46][47][48][49] • Drug no longer available 22 50 • No primary care provider or team member involved [51][52][53][54][55][56][57][58] • Design was non-randomized [59][60][61] • Previously included in a systematic review 23-31 34 62-65 • Study was a systematic review 19 21 66 • Study included non-overweight people. 67 After these exclusions, six publications representing four studies were reviewed in detail and data abstracted (table).…”