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Open Access Highly Accessed Research article

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

Kristiina Patja1*, Pilvikki Absetz1, Anssi Auvinen2, Kari Tokola2, Janne Kytö3, Erja Oksman4, Risto Kuronen4, Timo Ovaska3, Kari Harno5, Mikko Nenonen6, Tom Wiklund3, Raimo Kettunen4 and Martti Talja4

Author Affiliations

1 National Institute of Health and Welfare, Helsinki, Finland

2 School of Health Sciences, University of Tampere, Tampere, Finland

3 Pfizer Oy, Helsinki, Finland

4 Joint Authority for Päijät-Häme Social and Health Care, Lahti, Finland

5 Department of Social and Health Management, University of Eastern Finland (Kuopio Campus), Kuopio, Finland

6 Hartola Health Care Center Hartola, Finland and and Finnish Medical Association, Helsinki, Finland

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BMC Health Services Research 2012, 12:147  doi:10.1186/1472-6963-12-147

Published: 10 June 2012

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