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Patients were randomised to telephone health coaching (n=289) or usual care (n=288).Interventions Telephone health coaching intervention delivered by nurses, underpinned by Social Cognitive Theory.
Sixty per cent of primary care patients with COPD report exacerbations of their disease,10 which are associated with more rapid decline in lung function.14 Interventions that aim to reduce the severity of exacerbations include prompting early recognition of symptoms and rapid use of antibiotics or corticosteroids, or both, either through seeking a primary care appointment or use of a self treatment rescue drug pack.A sample of telephone consultations were recorded with the patients consent and reviewed by one researcher to determine compliance with the content of the intervention.Patients who had given informed consent and completed all the baseline measures were individually randomised in a 1:1 ratio to the telephone health coaching or usual care group stratified by centre.Social Cognitive Theory underpinned the intervention,26 and included education, monitoring, and assessment of progress, and taught skills with the aim of increasing self efficacy.2728 We incorporated best evidence for the promotion of physical activity (tailored, ongoing support, duration six months, use of pedometer).29303132 The intervention components are detailed in web appendix 1.The first telephone coaching session at one week after randomisation aimed to last 35-60 minutes (determined by the number of issues requiring discussion, such as current smoking), followed by a 15-20 minute telephone session at weeks 3, 7, and 11 with written supportive materials tailored to the patient after each telephone call (eg, summary of goals agreed, physical activity diary, contact details for local services, information leaflet showing correct inhaler use technique).One such approach is to use interactive telephone health coaching, with the coach and patient working together to identify barriers to behaviour change and finding ways to overcome them.
Key techniques include modelling behaviour, goal setting, and empowering the patient to improve their health status.4 Telephone health coaching has shown potential benefits on self efficacy, health behaviour, and health status in a rapid review of trials in long term conditions.5COPD is a common respiratory condition with an estimated 65 million people worldwide with moderate or severe disease.1 Like most chronic diseases, it causes a considerable burden on health services and society and is a leading cause of death in most countries.67 Interventions to support self management in patients with COPD have been shown to be effective in improving health related quality of life and in reducing hospital admissions among patients with COPD,89 but trials have largely recruited people from secondary care and excluded those with mild disease.9 However, patients with mild dyspnoea represent 38% to 54% of diagnosed patients in primary care.1011 This is likely to increase with case finding initiatives to identify disease in people with symptoms.12Many components of self management interventions could promote better health and prevent disease progression in the early stages of COPD.
92% of patients were followed-up at six months and 89% at 12 months.
There was no difference in SGRQ-C total score at 12 months (mean difference −1.3, 95% confidence interval −3.6 to 0.9, P=0.23).
The coaching promoted accessing smoking cessation services, increasing physical activity, medication management, and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). The usual care group received a leaflet about COPD.
Results The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of patients received all four calls.
Patients aged over 18 were identified as eligible if they were on the practice COPD register, thus had respiratory symptoms consistent with COPD; reported mild dyspnoea (MRC grades 1 (only breathless on strenuous exercise) or 2 (only get short of breath when hurrying on level ground or up a slight hill)) at the baseline assessment; had a forced expiratory volume in one second/forced vital capacity Patients who expressed an interest in the study were telephoned by a researcher and invited to a recruitment assessment at their practice, undertaken by a research nurse or trained researcher.