Abstract
BackgroundThe aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes.MethodsAn open-label cluster-randomized parallel groups trial. Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses, laboratory measures from electronic medical records (EMR). A total of 2594 patients filling inclusion criteria (age 45 years or older, with type 2 diabetes, coronary artery disease or congestive heart failure, and unmet treatment goals) were identified from EMRs, and 1535 patients (59%) gave consent and were randomized into intervention or control arm. Final analysis included 1221 (80%) participants with data on primary end-points both at entry and at end. Primary outcomes were systolic and diastolic blood pressure, serum total and LDL cholesterol concentration, waist circumference for all patients, glycated hemoglobin (HbA1c) for diabetics and NYHA class in patients with congestive heart failure. The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm.ResultsThe proportion of patients with diastolic blood pressure initially above the target level decreasing to 85 mmHg or lower was 48% in the intervention arm and 37% in the control arm (difference 10.8%, 95% confidence interval 1.5–19.7%). No significant differences emerged between the arms in the other primary end-points. However, the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm.ConclusionsIndividualized health coaching by telephony, as implemented in the trial was unable to achieve majority of the disease management clinical measures. To provide substantial benefits, interventions may need to be more intensive, target specific sub-groups, and/or to be fully integrated into local health care.Trial registrationClinicalTrials.gov Identifier: NCT00552903
Highlights
The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes
Comprehensive efforts to assess the impact of incorporating a range of IT tools in chronic disease management have been targeting single disease groups, such as CHD [10,11], heart failure [12] or diabetes [13,14]
Patients with more than one condition were enrolled in the following hierarchy: congestive heart failure (CHF) - coronary artery disease (CAD) - type 2 diabetes mellitus (T2D), so CHF patients could have CAD and/or T2D, but not the other way around
Summary
The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes. Despite differences between different conditions, the expectations on the patients are similar: to cope with multiple medications and co-morbidities, to alter behavior, to deal with social and psychological impacts of symptoms and to interact with medical care [3,4]. Health care providers have a difficult task in trying to manage chronic disease care in complex service systems that are poorly designed to motivate, equip and empower patients to behavior changes [5,6,7]. Comprehensive efforts to assess the impact of incorporating a range of IT tools in chronic disease management have been targeting single disease groups, such as CHD [10,11], heart failure [12] or diabetes [13,14]
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