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

• Published in: PloS one 2016-09, Vol.11 (9), p.e0161269-e0161269
• Main Authors: Härter, Martin, Dirmaier, Jörg, Dwinger, Sarah, Kriston, Levente, Herbarth, Lutz, Siegmund-Schultze, Elisabeth, Bermejo, Isaac, Matschinger, Herbert, Heider, Dirk, König, Hans-Helmut
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; Cancer; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Chronic conditions; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Clinical decision making; Clinical trials; Collaboration; Comorbidity; Coronary artery disease; Coronary vessels; Decision making; Diabetes; Diabetes Mellitus; Diagnostic systems; Disease control; Engineering and Technology; Health care expenditures; Health care policy; Health economics; Health promotion; Health Promotion - methods; Health services; Heart; Heart diseases; Heart Failure; Hospital costs; Humans; Hypertension; Immunoglobulins; Informed consent; Intervention; Medical research; Medicine and Health Sciences; Mental Disorders; Mental health; Mortality; Motivational interviewing; Occupational health; Patient Readmission; Patients; People and Places; Program Evaluation; Randomization; Regression analysis; Regression models; Research and Analysis Methods; Self Care; Social Sciences; Statistical analysis; Studies; Subgroups; Target marketing; Telemedicine; Telephone
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0161269

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. 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 corr