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.
Subject(s)
Coronary Disease/therapy , Diabetes Mellitus, Type 2/therapy , Health Promotion/methods , Heart Failure/therapy , Self Care , Telephone , Aged , Blood Pressure , Cholesterol/blood , Female , Finland , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Treatment Outcome , Waist CircumferenceABSTRACT
OBJECTIVE: To identify the most important referring parties in the Finnish health care system. DESIGN: A record linkage study based on nationwide administrative registers. SETTING: The hospital discharge register during 1996 to 2000. SUBJECTS: The total Finnish population and the population of four hospital districts. MAIN OUTCOME MEASURES: Discharges of individuals by the most important referring parties. RESULTS: The five most important referring parties in order of magnitude are as follows: health centre, no referral, clinic/unit of the same hospital, hospital other than a health centre, and private health care. The five most important referring parties for those aged over 75 are the same mentioned above. There were regional differences in referral practices. CONCLUSIONS: Differences or changes in referral profiles as a function of time cannot be taken as a direct measure of the impact of possible interventions or as an indication of an actual difference between the areas compared. One should also always be aware about any related meta-knowledge.
