Dennis Sarah M, Harris Mark, Lloyd Jane, Powell Davies Gawaine, Faruqi Nighat, Zwar Nicholas
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
Aust Health Rev. 2013 Jun;37(3):381-8. doi: 10.1071/AH13005.
To examine the effectiveness of telephone-based coaching services for the management of patients with chronic diseases.
A rapid scoping review of the published peer reviewed literature, using Medline, Embase, CINAHL, PsychNet and Scopus. We included studies involving people aged 18 years or over with one or more of the following chronic conditions: type 2 diabetes, congestive cardiac failure, coronary artery disease, chronic obstructive pulmonary disease and hypertension. Patients were identified as having multi-morbidity if they had an index chronic condition plus one or more other chronic condition. To be included in this review, the telephone coaching had to involve two-way conversations by telephone or video phone between a patient and a provider. Behaviour change, goal setting and empowerment are essential features of coaching.
The review found 1756 papers, which was reduced to 30 after screening and relevance checks. Most coaching services were planned, as opposed to reactive, and targeted patients with complex needs who had one or more chronic disease. Several studies reported improvements in health behaviour, self-efficacy, health status and satisfaction with the service. More than one-third of the papers targeted vulnerable people and telephone coaching was found to be effective for these people.
Telephone coaching for people with chronic conditions can improve health behaviour, self-efficacy and health status. This is especially true for vulnerable populations who had difficulty accessing health services. There is less evidence for improvements in quality of life and patient satisfaction with the service. The evidence for improvements in health service use was limited. This rapid scoping review found that telephone-based coaching can enhance the management of chronic disease, especially for vulnerable groups. Further work is needed to identify what models of telephone coaching are most effective according to patients' level of risk and co-morbidity. What is known about the topic? With the increasing prevalence of chronic diseases more demands are being made of limited health services and resources. Telephone health coaching for people with or at risk of chronic diseases is seen as a means of supporting people to manage their health and reducing the burden on the healthcare system. What does this paper add? Telephone coaching interventions were effective for vulnerable people with chronic disease(s). Often the vulnerable populations had worse control of their chronic condition at baseline and demonstrated the greatest improvement compared with those with better control at baseline. Planned (i.e. weekly or monthly telephone calls to support the patients with chronic disease) and unscripted telephone coaching interventions appear to be most effective for improving self-management skills in people from vulnerable groups: the planned telephone coaching services had the advantage of regular contact and helping people develop their skills over time, whereas the unscripted aspect allowed the coach to tailor support to the patient's individual needs What are the implications for practitioners? Telephone coaching is an effective means of supporting people with chronic diseases to manage their own health. Further work is needed to embed telephone coaching within existing services. Good linkages with the patient's general practitioner are important. This might be a regular report, updates via the patient e-health record, or provision for contact if a problem is identified or linking to the patient e-health record.
探讨基于电话的指导服务对慢性病患者管理的有效性。
使用Medline、Embase、CINAHL、PsychNet和Scopus对已发表的同行评审文献进行快速范围综述。我们纳入了涉及18岁及以上患有以下一种或多种慢性病的人群的研究：2型糖尿病、充血性心力衰竭、冠状动脉疾病、慢性阻塞性肺疾病和高血压。如果患者患有索引慢性病加一种或多种其他慢性病，则被确定为患有多种疾病。要纳入本综述，电话指导必须涉及患者与提供者之间通过电话或视频电话进行的双向对话。行为改变、目标设定和赋能是指导的基本特征。
该综述共找到1756篇论文，经筛选和相关性检查后减少至30篇。大多数指导服务是计划性的，而非反应性的，目标是有复杂需求且患有一种或多种慢性病的患者。几项研究报告了健康行为、自我效能、健康状况和对服务满意度的改善。超过三分之一的论文针对弱势群体，发现电话指导对这些人有效。
针对慢性病患者的电话指导可以改善健康行为、自我效能和健康状况。对于难以获得医疗服务的弱势群体尤其如此。关于生活质量改善和患者对服务满意度的证据较少。关于改善医疗服务使用的证据有限。这项快速范围综述发现，基于电话的指导可以加强慢性病管理，尤其是对弱势群体。需要进一步开展工作，以确定根据患者的风险水平和合并症，哪种电话指导模式最有效。关于该主题已知的情况是什么？随着慢性病患病率的上升，对有限的医疗服务和资源提出了更多需求。为患有慢性病或有慢性病风险的人提供电话健康指导被视为支持人们管理自身健康并减轻医疗系统负担的一种方式。本文补充了什么内容？电话指导干预对患有慢性病的弱势群体有效。通常，弱势群体在基线时对慢性病的控制较差，与基线时控制较好的人群相比，改善最为显著。计划性（即每周或每月致电支持慢性病患者）且无脚本的电话指导干预似乎对提高弱势群体的自我管理技能最有效：计划性电话指导服务具有定期联系的优势，并有助于人们随着时间的推移发展技能，而无脚本的方面则允许指导者根据患者的个人需求量身定制支持。对从业者有何启示？电话指导是支持慢性病患者管理自身健康的有效手段。需要进一步开展工作，将电话指导纳入现有服务中。与患者的全科医生建立良好联系很重要。这可能是定期报告、通过患者电子健康记录进行更新，或者在发现问题时提供联系方式或与患者电子健康记录建立链接。
