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

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 phones­of 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' comorbidities­40% (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 life­heart 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).

Use of email in communication between the Finnish primary healthcare system and general practitioners.

BACKGROUND: The volume of emails is rising rapidly everywhere. However, there is no data available concerning how primary healthcare physicians feel about the use of email communication between themselves, with their managers and with other people contacting them. OBJECTIVE: The objective of this study was to find out what the attitudes of primary care physicians are towards email at work. METHODS: The use of email was studied among a convenience sample of primary healthcare physicians. RESULTS: Physicians thought that email was a good instrument for delivering information but not as an instrument for leadership. Physicians in lead positions thought more often than ordinary general practitioners (GPs) that email is good for information. The leaders used email more actively than other GPs. The contents of the emails received by the GPs differed depending on the site of work. The total number of emails was higher in urban areas than in rural areas. Emails relating to administration, educational information and meeting materials were more often sent in rural than in urban primary healthcare settings. Information about daily work arrangements and about social events were more frequently emailed in urban than in rural surroundings. Email was considered important for information inside the system but a somewhat difficult tool for discussing complicated subjects. Generally, it was agreed that there was some unimportant information filtering through this medium to the target GPs. GPs were uncertain whether important data reached everybody who needed it or not. Still, almost everybody used the email system regularly and the use of it was considered relatively easy. GPs were generally prone to adopt advice and instructions given via email and implemented those in their working routines. The use of the email system was related to technical ability to use the system. The easier the GP thought that the email system was the more he used it. Rural GPs were more critical in applying advice shared via email than their counterparts in urban areas. In general, physicians thought that email was a good method for reaching many people at the same time. However, the main points of the messages may be missed and the whole email may sometimes not be read. CONCLUSION: Especially during periods of change in the workplace, it is very important that management is conducted personally. Care must be taken so that disinformation does not spoil the informative value of email in the administration of primary health care. The needed technical assistance should be given to everyone in order to get the best advantage from the use of the email system.