Implementing a Lifestyle Medicine Program via Telehealth to Optimize GERD Management in WTC First Responders

Details

• Personal Author:
  Meyer, J. D. ; Senay E
• Description:
  Overall, we have demonstrated, via this pilot/program developmental R21 award, that a Lifestyle Medicine program targeted at the reduction of GERD symptoms and reduction of medication use, can be effectively developed and used to intervene on lifestyle factors that may reduce GERD in a particularly vulnerable population with a high prevalence of GERD and its related conditions and sequelae. As well, the deliverability of the intervention through a telehealth interface, allowing frequent visits without difficulties in travel and related clinical access problems was demonstrated in this pilot program. Participants who met inclusion criteria underwent the full LMG Program clinical intervention. The intervention consists of self-administered baseline standardized questionnaires, initial telemedicine visits of one-hour duration, and subsequent follow-up visits of 20-40 min duration scheduled at 2-weeks after initial visit, then monthly through the 6 months of the intervention period. The intervention utilizes a standardized approach incorporating the "six pillars' of lifestyle medicine management. Subsequent visits assessed progress towards goals, engaging participant with motivational interviewing and CBT techniques (e.g., congratulate on any progress and/or reassess goals); addressing lapse/relapse; reinforcing relapse prevention; and linking to resources. Fifty-three patients were enrolled. Mean age overall was 59.6 years (SD 7.8); 26% were women. 38 participants completed at least one treatment visit; 24 completed 6 or more visits. Of those with at least one treatment visit, the median number of visits was 5.5. Mean GERD Health Related Quality of Life questionnaire scores in those completing the program (6+ visits) improved from 25.7 to 13.9; (mean individual difference score 11.8, p= 0.005 by paired t-test). Subscores for heartburn declined by 42% (11.8 to 6.9; p=0.05) and for regurgitation by 44% (10.3 to 5.8; p=0.04). Women had higher baseline GERD scores than men, although differences were not statistically significant, and both sexes exhibit comparable declines in GERD scores across the intervention to date. Total GERD scores deceased most substantially in those taking medications nearly every day (ie 6-7 days/week), from 39.4 to 11.1 or by 72%. Small improvements were seen in those taking meds less often, and all exhibited reductions in symptoms. GERD medication frequency (meds taken as needed in the previous week) decreased in 61% of patients and increased in only 14%. A median decrease in medication frequency overall of two days (out of seven) per week was noted (p< 0.02 by Wilcoxon signed-rank test). Participant satisfaction with their present health condition improved over the course of the intervention; those reporting they were 'neutral' or satisfied rose from 40.9% to 72.8% (for improvement in satisfaction score across intervention p = 0.004 by Wilcoxon signed-rank test). No participant indicated a decrease in satisfaction; of 13 who indicated they were initially 'dissatisfied,' 6 were 'neutral' at the end and one more was 'satisfied.' Self-rated level of health (10-point scale) increased from 6.5 to 7.0; with mean improvement of 0.5 points p = 0.02 by paired 2-sided t-test). Changes in time spent sleeping were not seen (median 6 hours in before- and after- questionnaires) although participant assessments of their difficulty staying awake during the day improved across the intervention (median before: 'several days' during the week; median after: 'not at all' with a >10% drop in those who had trouble 'more than half the days' or 'every day') Additionally, analyses are ongoing and will address additional lifestyle changes, including nutritional profiles and improvements in psychosocial profiles via additional questionnaires. Our efforts were successful in integrating the data tracking technology in monitoring data and incorporating patient survey information into clinical encounters as part of the intervention. We found generally seamless downloading of data from the Q-reviews software and easy incorporation of these data into analytic software. Additional assessment (eg responses to reminders, continuity of patient care, treatment, and responsiveness) await further analyses and assessment of both platform meta-data and acceptability responses from participants. Feasibility of the proposed intervention focuses on participants' acceptability, practicality, implementation, and integration. We modified questions from the Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), and the Feasibility of Intervention Measure, both valid and reliable measures of implementation outcomes. Patient behavior change is determined by the attainment of Action Step Plan goals at the 6-month conclusion of the study. In a mid-term program evaluation (9/16 completers) 100% rated the LM program as 5/5 for meeting approval, appealing and would recommend to friends. More recent analyses show that participants as of Sept 2024 (23/24 completers) rated the LM program highly in terms of acceptability (4.9/5), appropriateness (4.8/5), and feasibility (4.8/5). All participants agreed that they would recommend the LMG intervention to a friend (21/23 completely agree; 2/23 agree), and that the intervention was of high quality (19/23 completely agree; 4/23 agree). Over 90% of participants agreed that the LMG program helped them deal with their GERD more effectively, and 100% of participants were satisfied with the intervention. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Clinical Techniques Cohort Studies First Responders Gastroesophageal Reflux Disease GERD Intervention Effectiveness World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-12
• NIOSHTIC Number:
  nn:20070645
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-012247, 2024 Nov; :1-12
• Contact Point Address:
  Emily Senay, MD, Icahn School of Medicine at Mount Sinai 1, Gustave L. Levy Pl, New York, Ny 10029-6574
• Email:
  emily.senay@mssm.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20210701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20230630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:cffdeb609f69ffcc97ec7a1c7801ea99f30eaa463fab827f0e26dcd403bcbee6a06003f752ce5f31ca973094b383d8dda7e4ae59269320d1e8fc806c6f2289a2
• Download URL:
  https://stacks.cdc.gov/view/cdc/219275/cdc_219275_DS1.pdf
• File Type:
  [PDF - 359.04 KB ]