Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial

Kristiina Patja, Pilvikki Absetz, Anssi Auvinen, Kari Tokola, Janne Kytö, Erja Oksman, Risto Kuronen, Timo Ovaska, Kari Harno, Mikko Nenonen, Tom Wiklund, Raimo Kettunen, Martti Talja, Kristiina Patja, Pilvikki Absetz, Anssi Auvinen, Kari Tokola, Janne Kytö, Erja Oksman, Risto Kuronen, Timo Ovaska, Kari Harno, Mikko Nenonen, Tom Wiklund, Raimo Kettunen, Martti Talja

Abstract

Background: The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes.

Methods: An 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.

Results: The 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.

Conclusions: Individualized 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 registration: ClinicalTrials.gov Identifier: NCT00552903.

Figures

Figure 1
Figure 1
Flow Diagram. Distribution of study population from those filling inclusion criteria by the healthcare charts to those completed the intervention.
Figure 2
Figure 2
Pfizer Health Solutions has developed a tele-coaching intervention with 5 key functions and 8 recommendations to engage, inform, involve, and empower the patients in self-care.

References

    1. Geneau R, Stuckler D, Stachenko S, McKee M, Ebrahim S, Basu S, Chockalingham A, Mwatsama M, Jamal R, Alwan A, Beaglehole R. Raising the priority of preventing chronic diseases: a political process. Lancet. 2010;13:1689–1698.
    1. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: Health effects and cost-effectiveness. Lancet. 2010;20:1775–1784.
    1. Daar AS, Singer PA, Persad DL, Pramming SK, Matthews DR, Beaglehole R, Bernstein A, Borysiewicz LK, Colagiuri S, Ganguly N, Glass RI, Finegood DT, Koplan J, Nabel EG, Sarna G, Sarrafzadegan N, Smith R, Yach D, Bell J. Grand challenges in chronic non-communicable diseases. Nature. 2007;22:494–496.
    1. Davidson MB. How our current medical care system fails people with diabetes: Lack of timely, appropriate clinical decisions. Diabetes Care. 2009;2:370–372.
    1. Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care. 2005;11:253–260.
    1. Costa BM, Fitzgerald KJ, Jones KM, Dunning Am T. Effectiveness of IT-based diabetes management interventions: a review of the literature. BMC Fam Pract. 2009;10:72. doi: 10.1186/1471-2296-10-72.
    1. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15:231–240. doi: 10.1089/tmj.2008.0099.
    1. Wagner EH, Groves T. Care for chronic diseases. BMJ. 2002;26:913–914.
    1. Goode AD, Reeves MM, Eakin EG. Telephone-delivered interventions for physical activity and dietary behavior change: an updated systematic review. Am J Prev Med. 2012;42:81–88. doi: 10.1016/j.amepre.2011.08.025.
    1. DeBusk RF, Miller NH, Superko HR, Dennis CA, Thomas RJ, Lew HT, Berger WE, Heller RS, Rompf J, Gee D, Kraemer HC, Bandura A, Ghandour G, Clark M, Shah RV, Fisher L, Taylor CB. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994;120:721–729.
    1. Vale MJ, Jelinek MV, Best JD, Dart AM, Grigg LE, Hare DL, Ho BP, Newman RW, McNeil JJ. COACH Study Group. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Intern Med. 2003;163:2775–2783. doi: 10.1001/archinte.163.22.2775.
    1. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44:810–819.
    1. Taylor CB, Miller NH, Reilly KR, Greenwald G, Cunning D, Deeter A, Abascal L. Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Diabetes Care. 2003;26:1058–1063. doi: 10.2337/diacare.26.4.1058.
    1. Bu D, Pan E, Walker J, Adler-Milstein J, Kendrick D, Hook JM, Cusack CM, Bates DW, Middleton B. Benefits of information technology-enabled diabetes management. Diabetes Care. 2007;30:1137–1142. doi: 10.2337/dc06-2101.
    1. Hayes E, McCahon C, Panahi MR, Hamre T, Pohlman K. Alliance not compliance: Coaching strategies to improve type 2 diabetes outcomes. J Am Acad Nurse Pract. 2008;20:155–162. doi: 10.1111/j.1745-7599.2007.00297.x.
    1. Barrett MJ. Patient self-management tools: An overview. Californian Healthc Found. 2005. [read 6.11.2011]
    1. Olsen JM, Nesbitt BJ. Health coaching to improve healthy lifestyle behaviors: An integrative review. Am J Health Promot. 2010;25:e1–e12.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology. 2009;28:690–701.
    1. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. The Guilford Press, New York; 2008.
    1. Tokola K, Larocque D, Nevalainen J, Oja H. Power, sample size and sampling cost for clustered data. Stat Probab Lett. 2011;81:852–860. doi: 10.1016/j.spl.2011.02.006.
    1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D. et al.Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321:694–696. doi: 10.1136/bmj.321.7262.694.
    1. Kim SI, Kim HS. Effectiveness of mobile and internet intervention in patients with obese type 2 diabetes. Int J Med Inf. 2008;77:399–404. doi: 10.1016/j.ijmedinf.2007.07.006.
    1. Häkkinen U, Alha P. Health Service Utilization and its Socioeconomic Determinants. Health 2000 Survey. National Public Health Institute, Helsinki; 2006.
    1. Absetz P, Saaristo T, Viitasalo K, Peltonen M. In: Diabetes Prevention in Practice. Schwarz P, Reddy P, Greaves C, Dunbar J, Schwarz J, editor. Tumaini Institute for Prevention Management, Dresden; 2010. Implementation of prevention of type 2 diabetes – experiences from Finland.
    1. Absetz P, Valve R, Oldenburg B, Heinonen H, Nissinen A, Fogelholm M, Ilvesmäki V, Talja M, Uutela A. Type 2 diabetes prevention in the “real world”: one-year results of the GOAL implementation trial. Diabetes Care. 2007;30:2465–70. doi: 10.2337/dc07-0171.
    1. Oldenburg B, Absetz P, Chan CKY. In: Handbook of Behavioral Medicine: Methods and Applications. Steptoe A, Freedland KE, Jennings JR, Llabre MM, Manuck SB, Susman EJ, editor. Springer, Philadelphia; 2010. Behavioral interventions for prevention and management of chronic disease; pp. 969–988.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner