RESUMEN
Health disparities are documented between adults with intellectual and developmental disabilities (IDD) and neurotypical peers. As progress has been slow in improving health outcomes in people with IDD, the aim of this retrospective study was to compare effectiveness of a new Cross-Systems Care Integration (CSCI) model of care coordination to standard care coordination for 927 adults with IDD receiving Medicaid services in central Colorado from 2014 through 2017. Health care cost risk weight decreased (not statistically significant) only in individuals receiving the CSCI intervention. Depression diagnoses remained statistically unchanged, while both hypertension and hyperlipidemia significantly improved in patients receiving CSCI. Further study is warranted to extend duration of study and to examine additional study variables such as health-related quality of life.
Asunto(s)
Discapacidades del Desarrollo/epidemiología , Disparidades en Atención de Salud/estadística & datos numéricos , Discapacidad Intelectual/epidemiología , Medicaid/estadística & datos numéricos , Adolescente , Adulto , Colorado/epidemiología , Comorbilidad , Depresión/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Calidad de Vida , Estudios Retrospectivos , Riesgo , Estados Unidos , Adulto JovenRESUMEN
Coaching log notes for 15 participants from a 24-week blended online and telehealth randomized controlled trial were analyzed using thematic analysis and analyst triangulation to determine the factors that facilitated participant adherence to weight loss strategies, use of technology, and motivational interviewing. Several participants reported that restricting processed carbohydrates, limiting portion size, and maintaining healthy substitutions were effective nutritional strategies. Participants were less successful with adherence to their exercise goals, often due to time constraints and a lack of support. Results suggested consistent caregiver support improved participants' adherence to weight loss strategies and use of technology. Future programs should address obesity among people with intellectual and developmental disabilities by offering a range of interventions that are customized to their specific weight loss needs.
Asunto(s)
Discapacidad Intelectual/psicología , Programas de Reducción de Peso , Adulto , Femenino , Humanos , Masculino , Investigación Cualitativa , Cumplimiento y Adherencia al TratamientoRESUMEN
BACKGROUND: Intellectual disability (ID) is characterized by limitations in intellectual functioning and adaptive behavior. Adults with ID exhibit higher rates of obesity and poorer health status compared to the general population. Continuity of care and barriers to health-related activities may contribute to the poorer health status observed in this population. To address this problem, a tailored weight management online health information and communication technology platform, known as POWERSforID, was developed and is being tested to determine if this delivery mechanism can improve weight maintenance/weight loss in adults with ID. METHODS: Obese adults with mild-to-moderate ID (n = 70) are randomized to the POWERS forID intervention or control group for a 24-week trial. Each group undergoes an assessment that includes body weight, waist circumference, and percent body fat at baseline and at weeks 6, 12, and 24. Physical activity barriers, healthy eating barriers, food frequency, and psychosocial wellbeing are measured at baseline and at weeks 12 and 24. Blood lipids are assessed at baseline and 24 weeks. Participants randomized to POWERS forID receive access to the POWERS forID website and calls from a health coach (weekly during weeks 1-12, biweekly during weeks 13-24). The health coach employs motivational interviewing techniques adapted for individuals with ID to promote behavior change. Participants randomized to the control group receive standard clinical weight-loss care. Differences in weight, waist circumference, blood lipids, percent body fat, and psychosocial self-report will be assessed. Barriers and facilitators of implementation as well as perception of study outcomes will be conducted via qualitative analysis. DISCUSSION: POWERS forID is a novel information and communication technology platform designed to address health needs for adults with ID. This article describes the development and components of POWERS forID. The overall aim is to assess usability and feasibility of POWERS forID for promoting weight loss for obese adults with ID over the course of a 24-week randomized control trial. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03139760 . Registered on XXX.
Asunto(s)
Personas con Discapacidad/psicología , Ejercicio Físico , Estilo de Vida Saludable , Discapacidad Intelectual/psicología , Internet , Entrevista Motivacional , Obesidad/terapia , Telemedicina/métodos , Pérdida de Peso , Programas de Reducción de Peso , Protocolos Clínicos , Colorado , Dieta Saludable , Estudios de Factibilidad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Discapacidad Intelectual/complicaciones , Estado Nutricional , Obesidad/complicaciones , Obesidad/fisiopatología , Obesidad/psicología , Educación del Paciente como Asunto , Proyectos de Investigación , Factores de Tiempo , Resultado del TratamientoRESUMEN
Research supports intensive lifestyle interventions (>25 contact hours/six months) to treat childhood obesity. Success requires retention in program. This quality improvement project's purpose was to increase attendance of follow-up patients in a childhood obesity clinic by 10%. A pretest posttest design was used. Three months of baseline data were collected, followed by 52 weeks of intervention data. Data were analyzed using descriptive statistics and Fisher's exact test. Follow-up patient attendance improved significantly from 69% to 81% (z=1.76, p=.039 (95% CI=0.2822, 1.0021)). Simple and inexpensive interventions can significantly increase attendance of obese children in follow-up.