Telephone coaching – a new study highlights its benefits (and costs)

A new study published in the Australian Health Review has found that telephone coaching can help people with chronic diseases to self-manage their conditions and may be particularly useful in targeting vulnerable and disadvantaged populations.  However, the study author has warned against making assumptions about the cost of coaching relative to other forms of care, saying that the study found that in most cases it did not reduce health care costs and, in some cases, could increase them.

In commenting on the study, Australian Healthcare and Hospitals Association Chief Executive, Alison Verhoeven said that it addressed one of the greatest challenges facing our health system: the rising rate of chronic disease. She stated that this is occurring in all sectors of society but in particular affects vulnerable populations such as Aboriginal and Torres Strait Islander people, people who are socioeconomically disadvantaged and those living in rural remote areas. These groups also have less access overall to healthcare services which can further increase their chronic disease burden. The increased rate of individual chronic disease coupled with the uneven distribution of disease and inequitable access to health services is placing enormous pressure on our health system.

Dr Sarah Dennis, the study author said that health coaching to develop self-management skills including behaviour change, goal setting and empowerment can assist in reducing the burden of chronic disease on the healthcare system.  Her study looked at health coaching provided by healthcare professionals which aimed to equip patients with the skills and confidence they need to manage their health. It found that coaching can be used to address the impact of some of the health workforce shortages in many areas of Australia where people with chronic diseases may have direct access to many health services.

The study involved a review of the published, peer-reviewed literature and aimed to examine the effectiveness of telephone-based coaching services for the management of patients with one or more chronic diseases. The review found that most coaching services targeted patients with complex needs who had one or more chronic diseases. Several studies reported improvements in health behaviour, self-efficacy, health status and satisfaction with the service. Both planned (i.e. weekly or monthly telephone calls to support the patients with chronic disease) and unscripted telephone coaching interventions appear to be 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 services allowed the coach to tailor support to the patient’s individual needs.

In particular, the study found that coaching was effective for vulnerable people who typically had worse control of their chronic condition at baseline.  In general, people categorised as ‘vulnerable’ demonstrated the greatest improvement compared with those with better control at baseline.

The impact of telephone coaching on health service use is unclear. Overall, telephone coaching did not significantly reduce health service use and in some, health service use was increased with the intervention. However, the increase in service use may be related to improved quality of care, for example, through identifying the need for preventive or early intervention services.

Dr Dennis concluded that overall the found that telephone coaching can enhance the management of chronic disease, especially for vulnerable groups. However, further work is needed to embed telephone coaching within existing services and ensure good linkages with the patient’s general practitioner.  Additional research is also required to identify what models of telephone coaching are most effective according to patients’ level of risk and co-morbidity.