Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled TrialReportar como inadecuado




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Background

Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching TBHC in chronically ill patients.

Methods and Findings

This prospective, pragmatic randomized controlled trial compares an intervention group IG of participants in TBHC to a control group CG without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1 multiple conditions chronic campaign, 2 heart failure heart failure campaign, or 3 chronic mental illness conditions mental health campaign were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses DDD, frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching PSM was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios HR. Probability of hospital readmission and probability of death were analysed by calculating odds ratios OR. Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 IG: 2,713; CG: 2,596 in the chronic campaign, of 660 IG: 338; CG: 322 in the heart failure campaign, and of 239 IG: 101; KG: 138 in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG OR = 1.13; p = 0.045; no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions -0.41; p = 0.012, although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign OR = 0.64; p = 0.005 as well as in the heart failure campaign OR = 0.44; p = 0.001.

Conclusions

While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching.

Trial Registration

German Clinical Trials Register DRKS00000584



Autor: Martin Härter , Jörg Dirmaier , Sarah Dwinger, Levente Kriston, Lutz Herbarth, Elisabeth Siegmund-Schultze, Isaac Bermejo, Herb

Fuente: http://plos.srce.hr/



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