Unanswered Questions New Directions

Good progress has been made in medical office-based psychosocial interventions during the few years that this has been an area of investigation, but much more remains to be done. As summarized in Table 6.1, studies are particularly needed of the extent and characteristics of practices that adopt, implement and maintain such interventions. This conclusion is not unique to medical office-based interventions, but also applies to much of health psychology25. As research shifts to a broader focus that includes not only individual and intrapersonal determinants of health and behaviour, but also broader social-environmental determinants, setting and organization factors become an important area of investigation.

As this field of inquiry advances, the issues studied will shift from basic questions, such as 'Does this type of intervention work?', to more sophisticated questions, such as 'which types of intervention are most effective, for what purpose (e.g. increasing participation; producing immediate behaviour change; enhancing maintenance), with which type of patient, in which type of setting and when implemented by which type of interventionist?' Given the inherent advantages of consistent delivery, freeing staff time for other duties, automated and immediate scoring and feedback, and the high degree of individualization possible, we are likely to see much more application of interactive computer-based applications in medical settings. It is hoped that these applications will be evidence-based, and that they will be developed with a focus on the RE-AIM dimensions discussed above.

The final and most important challenge for the future remains optimal ways in which to integrate psychosocial assessments and interventions into regular medical office-based diabetes care, and to do so in a way that enhances quality of care and patient-centred outcomes.

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