Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial

Tuula Karhula, Anna-Leena Vuorinen, Katja Rääpysjärvi, Mira Pakanen, Pentti Itkonen, Merja Tepponen, Ulla-Maija Junno, Tapio Jokinen, Mark van Gils, Jaakko Lähteenmäki, Kari Kohtamäki, Niilo Saranummi, Tuula Karhula, Anna-Leena Vuorinen, Katja Rääpysjärvi, Mira Pakanen, Pentti Itkonen, Merja Tepponen, Ulla-Maija Junno, Tapio Jokinen, Mark van Gils, Jaakko Lähteenmäki, Kari Kohtamäki, Niilo Saranummi

Abstract

Background: There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases.

Objective: The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients.

Methods: A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels.

Results: A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients' unfamiliarity with mobile phones—of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients' comorbidities—40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables.

Conclusions: A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases.

Trial registration: ClinicalTrials.gov NCT01310491; https://ichgcp.net/clinical-trials-registry/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM).

Keywords: health coaching; health-related quality of life; heart disease; personal health record; telemonitoring; type 2 diabetes.

Conflict of interest statement

Conflicts of Interest: Tapio Jokinen is the chairman of the board of Medixine Ltd that provided the remote patient monitoring system.

Figures

Figure 1
Figure 1
Technical architecture of the health coaching system supported with remote patient monitoring.
Figure 2
Figure 2
The patient flow within the trial. H: patients with a diagnosis of ischemic heart disease or heart failure, D: patients with a diagnosis of diabetes mellitus type 2 and HbA1c > 6.5%.

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