Background: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF) with a population of 112,000 in Finland.
Methods: 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated to receive usual health care (control group, n = 501) or a combination of usual care and individual THC for 12 months (intervention group, n = 1034). The primary outcome was a composite of death from cardiovascular causes, non-fatal stroke, non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of eight years. Three other composite variables were also followed; cardiovascular mortality or morbidity, events of death from any cause, non-fatal AMI, non-fatal stroke, renal insufficiency, peripheral vascular disease and hospitalization due to congestive heart failure (CHF). Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis.
Results: The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated to the study.
Conclusions: No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching.
Trial registration: NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009)