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

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

Coaching and barriers to weight loss: an integrative review

“…It is centered on the client, focuses on behavioral change, provides feedback on the consequences of a behavior relative to health, and shows the discrepancies between the desired objective and the current behavior 13,15,17,18,23. In a motivational interview, the patient can be categorized according to his or her level of motivation: precontemplation (I do not want to do it or I cannot do it); contemplation (I want and can do it, but I will leave it for later); preparation (I am going to do it); action (I am doing it, but not regularly); and maintenance (I continue doing it) 13,23…”

“…Aimed at increasing patient self-efficacy, the self-monitoring technique has been discussed extensively 11,12,14,15,17,18,23. This technique enhances the patient’s attention and responsibility for his or her own actions, reducing his or her dependency on the professional.…”

“…In coaching, the objective tends to be specified using the SMART technique, that is, the goal must be specific, measurable, action-oriented, and realistic, and it must be able to be completed within a specific period of time 22,23. Using this tool, the future visualization of the results can be performed and a sense of purpose of the objective can be sought by presenting the participant with questions, such as “What will you be able to do when you accomplish it?” and “What will be different in your life?”22 In the TERVA study, the importance of the questioning technique was addressed, including the use of open questions, that is, questions that provoke answers with more content rather than simple responses, such as “yes” or “no.”17 After establishing the objective, the action planning tool is defined, in which the patient questions him- or herself about what he/she wants to accomplish, what he/she is going to do, how and when he/she will do it, who he/she can rely on, what resources he/she possesses, what resources he/she needs, and the time frame in which the objective should be accomplished. In this action plan, the patient is the protagonist in all of the tasks 16,17…”

Eight‐year post‐trial follow‐up of health care and long‐term care costs of tele‐based health coaching

“…Recruitment of participants from the health care services has been described in detail previously. 19 A total of 2,594 patients who fulfilled the eligibility criteria (age 45 years or older, with T2D, CAD or CHF, and unmet treatment targets) were randomized to either the intervention group or the control group with a 2:1 ratio. Of the eligible patients, 1535 (59.2 percent) gave consent: 1,034 in the intervention group and 501 in the control group.…”

“…There were no significant differences between the groups at baseline. 19 Patients with more than one disease were allocated to the highest morbidity disease group using the following hierarchy: 1) CHF, 2) CAD, and 3) T2D. T2D group criteria were medication and serum HbA1c > 7 percent (53 mmol/mol) without clinically evident cardiovascular diseases, for example, MI, stroke, or peripheral vascular disease.…”