Limits...
Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial.

Karhula T, Vuorinen AL, Rääpysjärvi K, Pakanen M, Itkonen P, Tepponen M, Junno UM, Jokinen T, van Gils M, Lähteenmäki J, Kohtamäki K, Saranummi N - J. Med. Internet Res. (2015)

Bottom Line: The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score.There were no differences in any other outcome variables.Diabetes patients may be more prone to benefit from this kind of intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Eksote, South Karelia Social and Health Care District, Lappeenranta, Finland.

ABSTRACT

Background: There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases.

Objective: The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients.

Methods: A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels.

Results: A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients' unfamiliarity with mobile phones—of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients' comorbidities—40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables.

Conclusions: A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases.

Trial registration: ClinicalTrials.gov NCT01310491; http://clinicaltrials.gov/ct2/show/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM).

No MeSH data available.


Related in: MedlinePlus

The patient flow within the trial. H: patients with a diagnosis of ischemic heart disease or heart failure, D: patients with a diagnosis of diabetes mellitus type 2 and HbA1c > 6.5%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4526947&req=5

figure2: The patient flow within the trial. H: patients with a diagnosis of ischemic heart disease or heart failure, D: patients with a diagnosis of diabetes mellitus type 2 and HbA1c > 6.5%.

Mentions: Figure 2 describes the progress of the trial. The electronic health records were utilized to screen patients with either heart disease or diabetes mellitus type 2. The diagnosis was either type 2 diabetes mellitus with HbA1c >6.5% or one of the following two heart diseases: ischemic heart disease or heart failure. The number of patients fulfilling the criteria was 1649 with heart disease diagnoses, and 1987 patients with diabetes diagnoses. Of these patients, 499 heart disease patients and 500 diabetes patients were randomly selected and received invitation letters in October 2010. The number of patients who refused to participate, changed their mind before the trial began, or did not show up at the baseline visit, was higher than expected. Therefore, the invitation procedure was repeated in November 2010 and August 2011 to achieve the predefined power for the pilot. In total, invitation letters were sent to 2084 patients, of which 28.02% (584) agreed to participate. Eventually, 595 patients were randomized and, of these, 519 patients (87.2%) attended the baseline visit. All participants filled out the baseline questionnaires before they were told into which group they were randomized.


Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial.

Karhula T, Vuorinen AL, Rääpysjärvi K, Pakanen M, Itkonen P, Tepponen M, Junno UM, Jokinen T, van Gils M, Lähteenmäki J, Kohtamäki K, Saranummi N - J. Med. Internet Res. (2015)

The patient flow within the trial. H: patients with a diagnosis of ischemic heart disease or heart failure, D: patients with a diagnosis of diabetes mellitus type 2 and HbA1c > 6.5%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526947&req=5

figure2: The patient flow within the trial. H: patients with a diagnosis of ischemic heart disease or heart failure, D: patients with a diagnosis of diabetes mellitus type 2 and HbA1c > 6.5%.
Mentions: Figure 2 describes the progress of the trial. The electronic health records were utilized to screen patients with either heart disease or diabetes mellitus type 2. The diagnosis was either type 2 diabetes mellitus with HbA1c >6.5% or one of the following two heart diseases: ischemic heart disease or heart failure. The number of patients fulfilling the criteria was 1649 with heart disease diagnoses, and 1987 patients with diabetes diagnoses. Of these patients, 499 heart disease patients and 500 diabetes patients were randomly selected and received invitation letters in October 2010. The number of patients who refused to participate, changed their mind before the trial began, or did not show up at the baseline visit, was higher than expected. Therefore, the invitation procedure was repeated in November 2010 and August 2011 to achieve the predefined power for the pilot. In total, invitation letters were sent to 2084 patients, of which 28.02% (584) agreed to participate. Eventually, 595 patients were randomized and, of these, 519 patients (87.2%) attended the baseline visit. All participants filled out the baseline questionnaires before they were told into which group they were randomized.

Bottom Line: The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score.There were no differences in any other outcome variables.Diabetes patients may be more prone to benefit from this kind of intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Eksote, South Karelia Social and Health Care District, Lappeenranta, Finland.

ABSTRACT

Background: There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases.

Objective: The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients.

Methods: A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels.

Results: A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients' unfamiliarity with mobile phones—of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients' comorbidities—40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables.

Conclusions: A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases.

Trial registration: ClinicalTrials.gov NCT01310491; http://clinicaltrials.gov/ct2/show/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM).

No MeSH data available.


Related in: MedlinePlus