Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?
BACKGROUND
Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.


OBJECTIVE
To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.


METHODS
Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).


METHODS
medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization).


METHODS
pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.


METHODS
Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.


METHODS
We measured secondary prevention behaviors, physical functioning, and quality of life.


RESULTS
QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.


CONCLUSIONS
Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.
Holmes-Rovner
Margaret
M
Center for Ethics, C203 E. Fee Hall, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA. mholmes@msu.edu
Stommel
Manfred
M
Corser
William D
WD
Olomu
Adesuwa
A
Holtrop
Jodi Summers
JS
Siddiqi
Azfar
A
Dunn
Susan L
SL
D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D037001:Directive Counseling; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D017216:Telemedicine