gms | German Medical Science

Background: Leading causes of death and disability are chronic diseases, like for example diabetes mellitus, heart diseases or cancer. Reasons can be the rapid ageing of the population, longer life expectancy, and medical progress. Chronic diseases are at least partially considered to be preventable or modifiable, for example by enhancing patients’ self-management. Telephone health coaching is one method to improve the self-management of chronically ill patients.

Design: This prospective, pragmatic randomized controlled trial compares an intervention group (IG) that receives coaching to a control group (CG) receiving usual care for a period of four years. Primary endpoint is two years after enrolment. The telephone coaching is provided by a statutory health insurance and includes evidence based information, motivational interviewing and collaborative goal setting. There are three different specially tailored coachings that will be analysed separately, called chronic, heart failure and psychiatric campaign.

Methods: Primary outcome was time from enrolment until hospital readmission within two years. Secondary outcomes included for example the probability of hospital readmission, number of daily defined doses (DDD) of medication, and frequency and duration of inability to work. Additionally we analysed the mortality within two years. All outcomes were analysed based on routine data provided by the statutory health insurance. Potential selection bias was minimized by propensity score matching (PSM). For the analysis of hospital readmission and mortality we calculated Kaplan-Meier curves and estimated hazard ratios. Probability of hospital readmission and probability of death were analysed by calculating odds ratios. Quantity of health service use and inability to work were analysed by linear random effects regression models. Intention-to-treat as well as per-protocol analysis are conducted.

Results: PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, 660 (IG: 338; CG: 322) in the heart failure campaign, and 239 (IG: 101; KG: 138) in the psychiatric campaign. In none of the campaigns IG and CG differed significantly regarding the time until hospital readmission within two-years. In the chronic campaign, the probability of hospital readmission was significantly higher in the IG than in the CG (OR=1.17 (SE=0.07)). No significant differences could be found for the other two campaigns. The IG of the heart failure campaign showed a significantly reduced number of hospital admissions (-0.41 (SE=0.22)), although the corresponding reduction in the number of hospital days was not significant. The IG of the chronic campaign showed significantly increased number of DDD (155.03 (SE=49.66)). All other regression results were not significant. Nevertheless, there were significant differences in mortality between IG and CG in the chronic campaign (OR=0.66 (SE=0.10)) and the health failure campaign (OR=0.47 (SE=0.11)).

Conclusion: A telephone health coaching intervention showed no effects on the “time until hospital readmission”. Also the effects on the secondary outcomes were rather small. However, mortality in the intervention group was significantly reduced. Possible reasons for these effects will be discussed.