An extensive body of evidence from efficacy trials, including several behavioral intervention trials conducted by the Hopkins investigators, has documented that weight loss is achievable. However, primary care providers typically had no direct involvement in the interventions. We propose a 3 group, randomized trial to determine the effectiveness of two integrated clinical-behavioral interventions (ICBIs). Participants will be 300 overweight or obese individuals with medication-treated hypertension, who are patients at two primary care clinics. The comparison group, as well as both ICBIs, will receive an evidence-based program to improve hypertension control. One ICBI, termed ICBI-IP, is a multi-channel intervention with in-person visits delivered by health counselors at the Hopkins center. This intervention is similar to traditional in-person interventions tested in efficacy trials;however, some in-person contacts are replaced with other types of contacts (telephone, web, email) in order to reduce costs and improve efficiency. The other ICBI, termed ICBI-Remote, is a multi-channel intervention (telephone, web, email) without in-person visits implemented by trained counselors of Healthways, Inc, a leading Disease Management company. This research effort builds upon previous research conducted by the investigators. Both ICBIs will be theory-guided interventions, adapted from PREMIER, an efficacy trial in which interventions lowered weight and controlled hypertension. Each ICBI will implement well-established behavioral techniques to accomplish weight loss, and each will use a web-based tool to facilitate communication among counselors, participants and clinicians;self- monitoring by participants;and feedback by counselors and clinicians. Both ICBIs will actively engage primary care providers. The primary outcome variable will be BMI and the secondary outcome hypertension control. Both ICBI should reduce weight. Critical questions are the extent of weight loss from each program. ICBI-IP might reduce weight to a greater extent than ICBI-Remote. Still, ICBI-Remote should be less expensive and more flexible. ICBI-IP could be implemented in a variety of settings (e.g. wellness programs, large clinics), while ICBI-Remote has the advantage of being readily 'scalable', that is, if successful, it could be rapidly implemented. In short, this translation study should provide the scientific foundation for efforts to control weight and improve hypertension control in overweight or obese medical patients.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01HL087085-04
Application #
7658838
Study Section
Special Emphasis Panel (ZHL1-CSR-R (S1))
Program Officer
Wells, Barbara L
Project Start
2006-09-25
Project End
2011-06-30
Budget Start
2009-07-01
Budget End
2010-06-30
Support Year
4
Fiscal Year
2009
Total Cost
$1,291,152
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Jerome, Gerald J; Alavi, Reza; Daumit, Gail L et al. (2015) Willingness to pay for continued delivery of a lifestyle-based weight loss program: The Hopkins POWER trial. Obesity (Silver Spring) 23:282-5
Bennett, Wendy L; Wang, Nae-Yuh; Gudzune, Kimberly A et al. (2015) Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial. Patient Educ Couns 98:1099-105
Tseng, Eva; Wang, Nae-Yuh; Clark, Jeanne M et al. (2015) Role of PCP referral and weight loss in the Hopkins POWER trial. Prev Med Rep 2:968-72
Gaglio, Bridget; Phillips, Siobhan M; Heurtin-Roberts, Suzanne et al. (2014) How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research. Implement Sci 9:96
Bennett, Wendy L; Gudzune, Kimberly A; Appel, Lawrence J et al. (2014) Insights from the POWER practice-based weight loss trial: a focus group study on the PCP's role in weight management. J Gen Intern Med 29:50-8
Jerome, Gerald J; Dalcin, Arlene; Coughlin, Janelle W et al. (2014) Longitudinal accuracy of web-based self-reported weights: results from the Hopkins POWER Trial. J Med Internet Res 16:e173
Rubin, R R; Peyrot, M; Wang, N-Y et al. (2013) Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial. Qual Life Res 22:2389-98
Jerome, Gerald J; Rubin, Richard R; Clark, Jeanne M et al. (2012) From efficacy to effectiveness: lessons learned from the Practice-Based Opportunities for Weight Reduction (POWER) trial. J Comp Eff Res 1:213-6
Gudzune, Kimberly A; Clark, Jeanne M; Appel, Lawrence J et al. (2012) Primary care providers' communication with patients during weight counseling: a focus group study. Patient Educ Couns 89:152-7
Glasgow, Russell E; Gaglio, Bridget; Bennett, Gary et al. (2012) Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Serv Res 47:1051-67

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