The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial (original) (raw)
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Population health management, 2009
The purpose of this study was to test the effect of computer-generated, tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a scheduled physician visit. A stand-alone computer application was developed to provide tailored feedback aimed at empowering patients to engage more actively in their diabetes management. Adults with type 2 diabetes (n = 203) were randomly assigned to groups receiving either efficacy (positive) messages (n = 68), risk (negative) messages (n = 67), or to a delayed treatment control group (n = 68). The intervention was delivered prior to a patient's visit with his or her physician so that patients would have the opportunity to discuss the messages at the clinical appointment. Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups, we learned that more directive messaging may b...
Internet-Based Chronic Disease Self-Management
Medical Care, 2006
Background: The small-group Chronic Disease Self-Management Program (CDSMP) has proven effective in changing health-related behaviors and improving health statuses. An Internet-based CDSMP was developed to reach additional chronic-disease patients. Objectives: We sought to determine the efficacy of the Internetbased CDSMP. Design: We compared randomized intervention participants with usual-care controls at 1 year. We compared intervention participants with the small-group CDSMP at 1 year. Subjects: Nine-hundred fifty-eight patients with chronic diseases (heart, lung, or type 2 diabetes) and Internet and e-mail access were randomized to intervention (457) or usual care control (501). Measures: Measures included 7 health status variables (pain, shortness of breath, fatigue, illness intrusiveness, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 3 utilization variables (physician visits, emergency room visits, and nights in hospital), and self-efficacy. Results: At 1 year, the intervention group had significant improvements in health statuses compared with usual care control patients. The intervention group had similar results to the small-group CDSMP participants. Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year. Conclusions: The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program.
The South Australia Health Chronic Disease Self-Management Internet Trial
Health Education & Behavior, 2013
Objectives. To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method. Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures, seven behaviors, and four utilization measures; self-efficacy; and health care satisfaction. Results. Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data. One hundred forty-four completed 6 months and 194 completed 1 year. Significant improvements (p < .05) were found at 6 months for four health status measures, six health behaviors, self-efficacy, and visits to emergency departments. At 12 months, five health status indicators, six health behaviors, selfefficacy, and visits to emergency departments remained significant. Satisfaction with health care trended toward significance. Discussion. The peer-led online program was both acceptable and useful for this population. It appeared to decrease symptoms, improve health behaviors, self-efficacy, and reduce health care utilization up to 1 year. This intervention also has large potential implications for the use of a public health education model for reaching large numbers of people. It demonstrates that an Internet self-management program, which includes social media, can reach rural and underserved people as well as be effective and reduce health care costs. If this intervention can be brought to scale, it has the potential for improving the lives of large numbers of people with chronic illness. It represents a way the medical care and public health sectors can interact.
Therapeutic Benefit of Internet-Based Lifestyle Counselling for Hypertension
Background: Preventive electronic (e)-counselling has been shown to reduce cardiovascular risk factors. However, heterogeneity in outcomes is commonly reported due to differences in e-protocols. We incorporated key features of an established behavioural therapy, motivational interviewing, to help standardize e-counselling in order to reduce blood pressure in patients with hypertension. Methods: Subjects (n ϭ 387, mean age ϭ 56 years, 59% female, 72% taking Ն 1 antihypertensive drug) were diagnosed with stage 1 or 2 hypertension. Subjects were randomized to a 4-month protocol of e-counselling (beta version of the "Blood Pressure Action Plan", Heart and Stroke Foundation of Canada) vs waitlist control (general e-information on heart-healthy living). Outcomes were sys-RÉSUMÉ Excluded: n = 324 308 failed screening criteria 15 declined to participate 1 polycystic kidney disease Eligible after initial screening: n = 458 85 (18.6%) Grey Bruce 242 (52.8%) Toronto 131 (28.6%) London Excluded: n = 71 71 withdrew Randomized N = 387 Completed telephone screening interview N = 782 Randomized to active control: n = 193 Withdrew: n = 35 (18.1%) Deaths (unrelated to trial): n = 1 Subjects included in the final analysis: 193 Randomized to treatment: n = 194 Withdrew: n = 45 (23.2%) Deaths (unrelated to trial): n = 0 Subjects included in the final analysis: 194 Figure 1. Patient flow diagram.
Computer-based interactive health communications for people with chronic disease
Smart Homecare Technology and TeleHealth, 2014
Chronic diseases (CD) -such as cardiovascular, diabetes, cancer, and chronic respiratory diseases -are projected to be the most common causes of mortality and morbidity by 2030. Use of a participatory decision-making model that emphasizes a partnership among practitioners, patients, and their families to achieve desired goals is a key strategy in achieving optimal outcomes. The Interactive Health Communication Applications (IHCAs) can support participatory decision making by providing the unique infrastructure needed to deliver support for the multiple requirements of patients with CD. The aim of this paper is to provide a descriptive review of the use of IHCAs in the treatment of chronic disease. Patient acceptability and satisfaction were identified as key issues that can be enhanced by ensuring that IHCAs provide: 1) emotional support and empowerment; 2) education and information from health professionals; and 3) telecommunication instead of onsite visiting. An important benefit of IHCAs can be an improved quality of communication between the patients and the health care professionals, which is a critical and predictive factor of treatment outcomes for many patients with CD. Similarly, there is good evidence to suggest that IHCAs can improve the patients' adherence to both medication and behavioral regimens designed to both treat and manage CDs. However, it is important to recognize that the technological development and effective implementation of an ICHA is a complex multidisciplinary operation that needs to take into account the needs of the various stakeholders as well as making use of the most suitable technology.
Journal of the American Medical Informatics Association, 2013
Objective To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes. Materials and methods Engaging and Motivating Patients Online With Enhanced Resources for Diabetes was a 12-month parallel randomized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin (A1C) values ≥7.5% from primary care sites sharing an electronic health record. The intervention included: (1) wirelessly uploaded home glucometer readings with graphical feedback; (2) comprehensive patient-specific diabetes summary status report; (3) nutrition and exercise logs; (4) insulin record; (5) online messaging with the patient's health team; (6) nurse care manager and dietitian providing advice and medication management; and (7) personalized text and video educational 'nuggets' dispensed electronically by the care team. A1C was the primary outcome variable. Results Compared with usual care (UC, n=189), patients in the intervention (INT, n=193) group had significantly reduced A1C at 6 months (−1.32% INT vs −0.66% UC; p<0.001). At 12 months, the differences were not significant (−1.14% INT vs −0.95% UC; p=0.133). In post hoc analysis, significantly more INT patients had improved diabetes control (>0.5% reduction in A1C) than UC patients at 12 months (69.9 (95% CI 63.2 to 76.5) vs 55.4 (95% CI 48.4 to 62.5); p=0.006). Conclusions A nurse-led, multidisciplinary health team can manage a population of diabetic patients in an online disease management program. INT patients achieved greater decreases in A1C at 6 months than UC patients, but the differences were not sustained at 12 months. More INT than UC patients achieved improvement in A1C (>0.5% decrease). Trial registered in clinical trials.gov: #NCT00542204 BACKGROUND
Journal of Medical Internet Research, 2020
Background: Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective: The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods: An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire,
Research Square (Research Square), 2022
Full list of author information is available at the end of the article Resumo Background: Behaviour change digital-assisted interventions can be a low-cost solution to enduring healthy behaviours. Understanding how to automate and tailor such interventions to patients' needs can improve health outcomes. This study aims at reviewing the evidence of the use of such interventions in a clinical setting in adult chronic patients. Methods: This study followed the PRISMA guidelines for comprehensive search, appraisal, and synthesis of research evidence. A literature search was performed to find studies published between 1 January 2017 and 26 March 2022 in peer-reviewed journals and written in English. Behaviour change interventions in adult chronic patients with automated and tailored communication systems were considered. Results: Seven quantitative studies (6 RCT and a pilot RCT) with sample sizes from 54 to 506 participants and timeframes varying from 4 to 30 weeks met the eligibility criteria. Populations comprehended patients with cardiovascular disease, chronic kidney disease, diabetes, or osteoarthritis. Communication channels included SMS, email, and voice records. Rule-based models were used to automate content in all studies and bidirectional communication was used in four of them. Content and service delivery were tailored given the patient's goals, needs, functional ability, activity, personal characteristics, and communication channel preferred. Most data management platforms used were developed in prior studies. Interventions were designed based on 9 different behaviour change models. There was no evidence of improvements in clinical outcomes after the intervention. Some studies showed improvements in self-efficacy (n=1), the use of dietary data info (n=1), physical activity (n=2), social support (n=1), and quality of life (n=1). The risk of bias analysis revealed that one study had moderate risk and the remaining had low risk. Conclusion: This study supports researchers that are designing digital behaviour change interventions by putting in evidence the intervention's features needed to be considered during this step. It revealed that the most efficient solutions were tailored to patients' needs and disease stages and that further research on the mechanisms of change and content automation needs to be done.