Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure – A randomized controlled trial

Abstract

PurposeTo evaluate the effects of person-centred support via telephone in two chronically ill patient groups, chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF).Method221 patients ≥ 50 years with COPD and/or CHF were randomized to usual care vs. usual care plus a person-centred telephone-support intervention and followed for six months. Patients in the intervention group were telephoned by a registered nurse initially to co-create a person-centred health plan with the patient and subsequently to discuss and evaluate the plan. The primary outcome measure was a composite score comprising General Self-Efficacy (GSE), re-hospitalization and death. Patients were classified as deteriorated if GSE had decreased by ≥ 5 points, or if they had been re-admitted to hospital for unscheduled reasons related to COPD and/or CHF or if they had died.ResultsAt six-month follow-up no difference in the composite score was found between the two study groups (57.6%, n = 68 vs. 46.6%, n = 48; OR = 1.6, 95% CI: 0.9–2.7; P = 0.102) in the intention-to-treat analysis (n = 221); however, significantly more patients in the control group showed a clinically important decrease in GSE (≥ 5 units) (22.9%, n = 27 vs. 9.7%, n = 10; OR = 2.8, 95% CI: 1.3–6.0; P = 0.011). There were 49 clinical events (14 deaths, 35 re-admissions) in the control group and 41 in the intervention group (9 deaths, 32 re-admissions). Per-protocol analysis (n = 202) of the composite score showed that more patients deteriorated in the control group than in the intervention group (57.6%, n = 68 vs. 42.9%, n = 36; OR = 1.8, 95% CI 1.0–3.2; P = 0.039).ConclusionPerson-centred support via telephone mitigates worsening self-efficacy without increasing the risk of clinical events in chronically ill patients with CHF and/or COPD. This indicates that a patient-healthcare professional partnership may be established without the need for face-to-face consultations, even in vulnerable patient groups.Trial registrationISRCTN.com ISRCTN55562827.

Promoting self‐efficacy in patients with chronic disease beyond traditional education: A literature review

“…The main characteristics of the sources reviewed were the implementation of an intervention to promote self‐management of the patients' disease(s) and identify behaviour effects and promotion of regimen adherence. Interventions included mobile phone applications (Baron, Hirani, & Newman, ; Hardinge et al, ), gaming (Hickman, Clochesy, Pinto, Burant, & Pignatiello, ), telehealth that included telephone or video streaming (Cameron et al, ; CottrellGalea, O'Leary, Hill, & Russell, ; Fors et al, ; Kennedy et al, ), self‐management programmes (Bratzke, ; Cutler et al, ; Devan et al, ; Fortin, Chouinard, Diallo, & Bouhali, ; Horrell et al, ; Lin, Liu, Hsu, & Tsai, ; Win et al, ), social media (van Berkel et al, ; Wilson et al, ), surveys addressing self‐efficacy (Henselmans et al, ; Koch et al, ; Roncoroni, Tucker, Wall, Wippold, & Ratchford, ; Wu et al, ) and health literacy survey (Mackey, Doody, Werner, & Fullen, ; Stellefson et al, ).…”

“…Koch et al () described support systems as being formal—health organization groups—and informal—peer groups and family. Several reviewed articles identified a lack of support, either formal or informal, being a barrier to self‐efficacy and positive patient outcomes (Cameron et al, ; Fors et al, ; Henselmans et al, ; Koch et al, ; Stellefson et al, ; Willis, ).…”

“…("Telemedicine and Telehealth," ). Interventions via telephone and video were prominent in this review (Cameron et al, ; Cottrell et al, ; Fors et al, ; Kennedy et al, ). In addition, a small number of mobile applications and gaming were identified as potential interventions to promote self‐efficacy.…”

“…Simply shifting to patient‐centred care and placing the patient at the centre to have an active role in their ongoing health care is not a one‐size‐fits‐all approach (Fors et al, ). When deriving strategies to improve self‐efficacy, there are many angles to consider.…”

“…Furthermore, Anekwe and Rahkovsky () argue that any patient with a chronic disease, no matter the type, needs a skill set for managing it and self‐efficacy is one of them. Self‐efficacy is a mediator between knowledge and self‐care (Wu et al, ), and exploring strategies to boost self‐efficacy will improve health outcomes in patients navigating chronic diseases (Cutler et al, ; Fors et al, ; Willis, ).…”