The effectiveness of proactive telephone coaching and tailored support (PROTECTS) for people with multimorbidity: A pragmatic, two-arm, cohort multiple randomised controlled trial.

Problem

Recent policy documents emphasise the need for integration of healthcare and support for people with multimorbidity. Health coaching is designed to provide an accessible, proactive service to patients for improving support and reducing inappropriate care utilisation. However, current evidence on the effectiveness of health coaching is mixed.

Approach

We evaluated the effectiveness of telephone coaching and support intervention for older people with multiple long-term conditions. A pragmatic, two-arm, cohort multiple randomised controlled trial (cmRCT) was conducted as part of the CLASSIC cohort study (n=4377 patients with long-term conditions) in Salford. Randomisation was undertaken at patient level. Patients aged 65 and older with 2 or more long-term conditions and a moderate level of patient activation at baseline were eligible for inclusion in the trial. Study outcomes were measured at baseline and 20 months. The intervention involved telephone health coaching delivered by non-specialist health advisors. The primary outcome was patient activation (PAM) and secondary outcomes were health-related quality of life (WHOQOL-BREF physical health), depression (MHI-5), and self-care (SDSCA).

Findings

A total of 1306 were eligible to take part in PROTECTS. 504 were randomly selected to receive the telephone health coaching intervention and the remaining 802 comprised the control group. Approximately half of the patients (46%) met the criteria for depression at baseline. 928 patients (71%) completed the 20 month follow-up. No statistically significant differences were found between patients in the intervention group and those in the control group on any of the primary or secondary outcomes. Cost-effectiveness analyses will be presented at the conference.

Consequences

An intervention to enhance activation, mood and support in older patients with multimorbidity did not improve self-reported self-management or quality of life. The active components required for improving support and reducing inappropriate care utilisation in older patients with multimorbidity need to be better understood.