Evidence map›Paper›PMID 29843795›Full record

ArticleBMC medicine2018

Is telephone health coaching a useful population health strategy for supporting older people with multimorbidity? An evaluation of reach, effectiveness and cost-effectiveness using a 'trial within a cohort'.

Maria Panagioti, David Reeves, Rachel Meacock, Beth Parkinson, Karina Lovell, Mark Hann, Kelly Howells, Amy Blakemore, Lisa Riste, Peter Coventry and 3 more

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In one paragraph

Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Maria PanagiotiNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
David ReevesNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Rachel MeacockManchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
Beth ParkinsonManchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
Karina LovellSchool of Nursing, Midwifery & Social Work, University of Manchester, Manchester, M13 9PL, UK.
Mark HannNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Kelly HowellsNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Amy BlakemoreSchool of Nursing, Midwifery & Social Work, University of Manchester, Manchester, M13 9PL, UK.
Lisa RisteNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Peter CoventryMental Health and Addiction Research Group, Department of Health Sciences and Hull York Medical School, University of York, York, YO10 5DD, UK.
Thomas BlakemanNIHR Collaboration for Leadership in Applied Health Research and Care - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
Mark SidawaySalford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
Peter BowerNIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK. peter.bower@manchester.ac.uk.ORCID 0000-0001-9558-3349

Funding

Department of Health 12/130/33Health Services and Delivery Research Programme 12/130/33
6 · The paper itself

Abstract

backgroundInnovative ways of delivering care are needed to improve outcomes for older people with multimorbidity. Health coaching involves 'a regular series of phone calls between patient and health professional to provide support and encouragement to promote healthy behaviours'. This intervention is promising, but evidence is insufficient to support a wider role in multimorbidity care. We evaluated health coaching in older people with multimorbidity.

methodsWe used the innovative 'Trials within Cohorts' design. A cohort was recruited, and a trial was conducted using a 'patient-centred' consent model. A randomly selected group within the cohort were offered the intervention and were analysed as the intervention group whether they accepted the offer or not. The intervention sought to improve the skills of patients with multimorbidity to deal with a range of long-term conditions, through health coaching, social prescribing and low-intensity support for low mood.

resultsWe recruited 4377 older people, and 1306 met the eligibility criteria (two or more long-term conditions and moderate 'patient activation'). We selected 504 for health coaching, and 41% consented. More than 80% of consenters received the defined 'dose' of 4+ sessions. In an intention-to-treat analysis, those selected for health coaching did not improve on any outcome (patient activation, quality of life, depression or self-care) compared to usual care. We examined health care utilisation using hospital administrative and self-report data. Patients selected for health coaching demonstrated lower levels of emergency care use, but an increase in the use of planned services and higher overall costs, as well as a quality-adjusted life year (QALY) gain. The incremental cost per QALY was £8049, with a 70-79% probability of being cost-effective at conventional levels of willingness to pay.

conclusionsHealth coaching did not lead to significant benefits on the primary measures of patient-reported outcome. This is likely related to relatively low levels of uptake amongst those selected for the intervention. Demonstrating effectiveness in this design is challenging, as it estimates the effect of being selected for treatment, regardless of whether treatment is adopted. We argue that the treatment effect estimated is appropriate for health coaching, a proactive model relevant to many patients in the community, not just those seeking care.

trial registrationInternational Standard Randomised Controlled Trial Number ( ISRCTN12286422 ).

Indexed as

Patient Acceptance of Health CareAgedAged, 80 and overCost-Benefit AnalysisFemaleHumansMaleMiddle AgedMultimorbidityPopulation HealthQuality of LifeTelephonedepressionhealth coachingmultimorbidityolder adults

Identifiers

PMID29843795
PMCPMC5975389

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.