Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls

Thank you very much for publishing this article by: Steventon A, Tunkel S, Blunt I, Bardsley M. Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls. BMJ (Clinical research ed.) 2013; 347 f4585.

The paper found a significant increase in usage of health services in general in participants who were given phone coaching rather than the control group contrary to what was expected.

The study population excluded those patients who hadn’t been using hospital services within the past 3 years as an outpatient or an inpatient. This implies that their condition is stable and is well managed. However, I feel excluding these patients would lead to less reliable results as a sudden change in circumstances may cause the patient to visit hospital. Data would therefore be lost. I feel that ideally these patients should also have been included in the study.

For an intervention like this to work, it is important to build a solid patient-doctor relationship. If this kind of rapport is not build than the information passed to the patient may be considered invalid and the patient may choose not to act upon any advice given. However, this is natural variability in practice that we find in medicine between physicians. Indeed it has been found that building an effective patient-centred relationship improves patient adherence to treatment regimes [1]. Adequate training and support for the physicians would ensure that this issue is kept down to a minimum.

There are differences in the way people choose to deal with the diagnosis of a chronic condition. Some may choose to ignore whereas others may take note of all advice that is given to them. This variability is not taken into account in the paper. This is not under the control of the authors [2]. Tools like patient reported outcomes (PROMs) could be used to see whether the patient finds the intervention effective. Also, the patients could be asked about their own adherence to see how closely they are following the advice given.

Thank you

References

1)AM Delamater. Improving Patient Adherence. Clinical Diabetes 2006 vol. 24 no. 2 71-77

2)White CA. Cognitive behavioral principles in managing chronic disease. The Western journal of medicine 2001;175(5) 338-342.