Biomedical subjects

H G McKay

Publications and source records attributed to H G McKay.

6 recordsLinked to original sources

PubMed2001

The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management?

BACKGROUND: The RE-AIM framework is used as a method of systematically considering the strengths and weaknesses of chronic illness management interventions in order to guide program planning. METHOD: The RE-AIM dimensions of Reach, Efficacy, Adoption, Implementation, and Maintenance are used to rate one-on-one counseling interventions, group sessions, interactive computer-mediated interventions, telephone calls, mail interventions, and health system policies. RESULTS: The RE-AIM ratings suggest that, although often efficacious for those participating, traditional face-to-face intervention modalities will have limited impact if they cannot be delivered consistently to large segments of the target population. Interventions using new information technologies may have greater reach, adoption, implementation, and maintenance, and thereby greater public health impact. Policy changes received high ratings across a variety of RE-AIM dimensions. CONCLUSIONS: Program planners should make decisions regarding implementing and funding health services based on multiple dimensions, rather than only considering efficacy in randomized clinical trials. Doing so may improve the resulting public health impact. Directions for future chronic illness management research related to RE-AIM, and implications for decision making, are described.

Chronic Disease↗

PubMed2001

The diabetes network internet-based physical activity intervention: a randomized pilot study.

OBJECTIVE: Because of other competing priorities, physical activity (PA) is seldom addressed in a consistent way in either primary care or diabetes education. This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels. RESEARCH DESIGN AND METHODS: A total of 78 type 2 diabetic patients (53% female, average age 52.3 years) were randomized to the Diabetes Network (D-Net) Active Lives PA Intervention or an Internet information-only condition. The intervention condition received goal-setting and personalized feedback, identified and developed strategies to overcome barriers, received and could post messages to an on-line "personal coach," and were invited to participate in peer group support areas. Key outcomes included minutes of PA per week and depressive symptomatology. RESULTS: There was an overall moderate improvement in PA levels within both intervention and control conditions, but there was no significant improvement in regard to condition effects. There was substantial variability in both site use and outcomes within the intervention and control conditions. Internal analyses revealed that among intervention participants, those who used the site more regularly derived significantly greater benefits, whereas those in the control condition derived no similar benefits with increased program use. CONCLUSIONS: Internet-based self-management interventions for PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions. We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time.

Computer Communication Networks↗

PubMed1999

Interactive computer technology, behavioral science, and family practice.

In this paper we discuss conceptual and practical uses for interactive computer applications (ICAs) for family practice, with an emphasis on implications for patient self-management, physician-patient relationships, primary care research, and health care systems quality improvement. We discuss recent behavioral science advances in patient self-management and the advantages and potential limitations of ICAs for medicine. We describe the benefits and risks of using ICAs for providing information, coping-skills training, and social support for patients and for improving the consistency and quality of care given by physicians. There are currently many effective ICAs, and they will play a central role in future health care. There is also the risk of inappropriate use of ICAs. We provide a summary of the empirical literature examining the use of ICAs to aid patients and providers in behavioral change and guidelines adherence efforts. We advise those people researching and applying ICAs in health care to be bold in what they attempt, but cautious in what they claim. Rigorous scientific evaluation and standardized reporting criteria can help quicken this advance, and there are important policy and ethical issues to consider. We conclude with a list of issues for family practices to consider when selecting and using ICAs.

Ambulatory Care Information Systems↗

PubMed1996

Patient-physician interactions in diabetes management: consistencies and variation in the structure and content of two consultations.

The structure and content of medical consultations concerning diabetes were examined in two, successive quarterly medical consultations between two physicians and their diabetes patients (N = 44). The consultations were audio-taped and coded for structure (e.g. question asking, information giving) using a modified version of the Roter Interactional Analysis System (inter-coder correlations typically exceeded 0.90 for the composite variables derived from the coding system). The tapes were also coded for content by monitoring the topics discussed (e.g. diet, medication, exercise). The majority of the interactions consisted primarily of information giving and positive talk on the part of both patients and providers. Nutrition-related issued, blood glucose monitoring, medication and exercise were addressed in the majority of interactions, but other regimen areas such as foot care, smoking habits, and alcohol were seldom discussed. There was little stability across the two consultations in terms of either structure (median test-retest correlation = 0.24) or content (majority of test-retest correlations were below 0.30). The importance of studying more than one patient-physician encounter when studying interaction style and content is discussed, as is the need for investigation of interactions between non-physician health care providers and patients with chronic disease.

Diabetes Mellitus↗

PubMedDate not supplied

Who participates in Internet-based self-management programs? A study among novice computer users in a primary care setting.

PURPOSE: The purpose of this study was to evaluate the participation rates and factors associated with nonparticipation among primary care patients who were invited to join an Internet-based self-management research program. METHODS: Primary care providers invited their patients with type 2 diabetes to participate in an Internet-based diabetes self-management support program. Research staff contacted these patients by phone to assess their eligibility and interest in participating. Reasons for declining were assessed and demographic/medical status information was collected. RESULTS: Of the eligible patients, 60% participated in the program. No significant differences were found between participants and decliners in gender, insulin use, computer familiarity, or computer ownership. There were significant differences in age and years since diagnosis. Participants were slightly younger and had diabetes for a fewer number of years than nonparticipants. Nonparticipation was not related to computer or Internet issues. CONCLUSIONS: Most older diabetes patients without previous Internet experience will take part in Internet-based self-management support programs if barriers to participation are addressed.

Aged↗

PubMedDate not supplied

Feasibility and use of an Internet support service for diabetes self-management.

Diabetes self-management is a challenging task due to its complexity and ever-present barriers to self-care. A key issue for patients, providers, and healthcare systems is how to deliver personalized behavioral support in ways that are affordable and can reach most patients. The Internet offers several advantages in this regard because it is available 24 hours a day, low cost, and capable of reaching thousands of patients. Although Internet sites for diabetes support are popular, they have not been evaluated. For this study, a Web site for diabetes self-management that emphasized personalized goal setting, feedback, and social support was developed. Over a 10-week period, 111 different persons logged onto D-NET for a total of 21,046 accesses. Users included persons across a broad age range (up to age 77 years) and duration of diabetes. The most popular areas of the site were the Social Support Conference and the Diabetes Information Pages. User ratings revealed high satisfaction with the service. The Internet has great potential for providing needed support and services for patients with diabetes and other chronic illnesses.

Adolescent↗