Abstract
ObjectiveTelephone based health coaching (TBHC) seems to be a promising approach to foster self-management in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany.MethodsPatients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen’s single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation.ResultsOf the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant between-group comparisons regarding these changes supported the findings. Standardized effect sizes were small. TBHC did not show any effect on mental QoL, health status, alcohol, smoking, adherence, measuring blood sugar, foot monitoring, anxiety, depression and distress. Campaign-specific subgroup effects were detected for ‘foot monitoring by a physician’ and ‘blood sugar measurement’.ConclusionTBHC interventions might have small effects on some patient reported and behavioral outcomes.Practice implicationsFuture research should focus on analyzing which intervention components are effective and who profits most from TBHC interventions.RegistrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS): DRKS00000584
Highlights
Due to better medical treatment and changes in demographics, an ageing population will result in increasing numbers of people living with chronic conditions
Future research should focus on analyzing which intervention components are effective and who profits most from Telephone based health coaching (TBHC) interventions
10,815 patients were eligible for TBHC, with 7,582 allocated to intervention group (IG) (70%) and 3,233 allocated to control group (CG) (30%)
Summary
Due to better medical treatment and changes in demographics, an ageing population will result in increasing numbers of people living with chronic conditions. In Europe, chronic conditions account for 80% of the mortality; diseases of the circulatory system account for nearly 50% [1, 2]. In addition to those patients affected by one chronic condition (24.3%), the proportion of multimorbid patients is very high: 13.8% had two and 11.7% had more than three chronic conditions [3], resulting in a reduction in life expectancy by about 1.8 years with each additional chronic condition for a 67-year old individual [4]. Cardiovascular diseases for example are responsible for the most lost “disability-adjusted lifeyears” (DALYs) in low- and middle-income countries in Europe, and the third most lost DALYs in high-income countries [1, 7]
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