One-to-one telephone health coaching does not seem to reduce hospital use and related costs for patients with long-term conditions (LTCs) - and may even lead to increased use, say UK researchers.
Health coaching might be more effective if it were better integrated into patients’ care pathways, or coupled with other interventions, they suggest, reporting their findings on bmj.com.
Telephone health coaching provides guidance and support to patients with LTCs, with regular phone calls to promote healthy behaviours, help patients manage their conditions more independently and identify any problems before they become critical. In this way, hospital admissions can be reduced, saving healthcare costs, it is hoped.
The Department of Health commissioned researchers at Ernst & Young and the Nuffield Trust to evaluate the impact of Birmingham OwnHealth - England's largest telephone health coaching service - on hospital use and associated costs.
They analysed data from the first two years of the scheme (2006-08), involving 2,698 patients, aged 65 on average, with a range of LTCs and a history of inpatient/outpatient hospital use.
These intervention patients received a personalised care plan and a monthly telephone call from a care manager. Matched control patients received usual care, with no telephone coaching.
But the researchers found the annual number of emergency admissions actually increased by 0.05 per head more among the intervention patients than the matched controls - a relative increase of 13.6%.
Moreover, outpatient attendances increased 0.03 per head more among intervention patients than controls, while secondary care costs rose £175 per head more among the former than the latter.
Commented on the findings, Nuffield Trust senior research analyst Adam Steventon noted that policymakers hope that, by improving community-based care, unnecessary hospital admissions can be avoided, but Birmingham OwnHealth appears not to have achieved this aim, at least in the period studied.
"However, the effect of new services depends ofnthe details of how they are implemented, and on the surrounding context, so it might be possible to improve the model," he suggested.
And the question remains whether other parts of the NHS could implement health coaching, he said. More needs to be done about the elements that make up a successful hospital avoidance programme, and "one of the largest lessons is to try to use some of the techniques that we implemented on an ongoing basis to improve care,” he stressed.