March 4, 2014

New online care from dietitians helps control weight

Overweight Group Health patients with hypertension benefit from ‘pocket dietitian’

eCare_mobile_healthy_living_1col.jpgSeattle, WA—A rich chocolate cake is tempting you, but where is a dietitian when you need one? The e-Care for Heart Wellness study sought to solve this problem. In the study, Group Health patients who were overweight and had hypertension were more likely to have lost 10 pounds in six months if they had secure online access to a dietitian than if they received only information and usual care. The American Journal of Preventive Medicine published the e-Care study.

“One patient said, ‘It’s like having a dietitian in your pocket,’” said Beverly B. Green, MD, MPH, a family doctor at Group Health, an associate investigator at Group Health Research Institute, and an assistant clinical professor in family medicine at the University of Washington (UW) School of Medicine. “The patients really loved this intervention—and having access to a dietitian to work with them toward a healthier lifestyle.”

 

In addition to team-based care led by a dietitian, the patients in the intervention group were given a home blood pressure monitor, a scale, and a pedometer. They each had one in-person visit with a dietitian where, together, they created a plan to reduce their heart risk, including the Dietary Approaches to Stop Hypertension (DASH) diet, with eight to 10 servings of vegetables and fruits per day. The DASH diet is not about eating less food, just more of the right food, Dr. Green said, quoting a patient who said: “All those fruits and vegetables kept me full and less likely to eat something I might regret later.”

The visit to the dietitian was followed by planned follow-up by secure messaging (through Group Health’s website for patients) to report their blood pressure, weight, and vegetable and fruit intake—and to receive ongoing feedback. When appropriate, the dietitians also encouraged patients and their doctors to consider changes to their hypertensive and lipid-lowering medication dosages.

Of the 90 people who completed six-month follow-up, the 44 who had been randomly assigned to receive dietitian e-care had higher rates of patient satisfaction and of use of Group Health’s secure messaging than did the 46 assigned to education and usual care. Although blood pressure and heart risk trended lower in the intervention group, the differences weren’t significant—unlike their weight.

“Heart disease and stroke are the number-one cause of death in the United States, but they don’t have to be,” Dr. Green said. “If people had better control of their heart risk factors such as blood pressure and cholesterol, and we could prevent or decrease obesity, we could cut the number of heart deaths in half.” And that’s just what she’s been trying to do, by shifting health care from the doctor's office to where people live: in their homes—and online.

In a previous large randomized controlled trial, called e-BP (Electronic Blood Pressure) and published in JAMA, Dr. Green showed that when people checked their blood pressure at home and received Web-based care from pharmacists, they were nearly twice as likely to get their blood pressure under control (under 140/90 mm Hg)— and cost-effectively, without office visits. In that study, the emphasis was on following standard guidelines to boost doses, switch, and combine hypertension drugs. Although the pharmacists helped patients set lifestyle goals, weight loss was not statistically significant. That’s why Dr. Green launched the e-Care study.

Next steps, since this study proved the intervention is feasible? Combining the e-Care and e-BP studies, which were both based on the Chronic Care Model. “We’re planning a larger randomized controlled trial, where we will tailor the e-care for the patients who have hypertension,” Dr. Green said. “We’ll pair each patient with either a pharmacist or a dietitian, depending on their individual needs.”

The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) funded this research: grant RC1HL100590, trial registration number NCT01077388.

American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in prevention research, teaching, practice, and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral, and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.

About Kaiser Permanente Washington Health Research Institute

Kaiser Permanente Washington Health Research Institute (KPWHRI), formerly Group Health Research Institute, improves the health and health care of Kaiser Permanente members and the public. The Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems since 1983. Government and private research grants provide our main funding. Follow KPWHRI research on Twitter, Facebook, Pinterest, LinkedIn, or YouTube. For more information, go to: www.kpwashingtonresearch.org.

About Kaiser Permanente 

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 11.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. For more information, go to: kp.org/share.

Co-Researchers

Paul A. Fishman, PhD

Senior Investigator
Kaiser Permanente Washington Health Research Institute

Jennifer B. McClure, PhD

Director of Research, Faculty, & Development; Senior Investigator
Kaiser Permanente Washington Health Research Institute

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Andrea J. Cook, PhD

Senior Investigator
Kaiser Permanente Washington Health Research Institute

Melissa L. Anderson, MS

Senior Biostatistician
Kaiser Permanente Washington Health Research Institute

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Media contact

For more on Kaiser Permanente Washington Health Research Institute news, please contact:

Rebecca Hughes

hughes.r@ghc.org

206-287-2055
After-hours media line: 206-448-4056

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