Nurse phone coaching program didn't improve outpatient glycemic control

A nurse-delivered phone coaching initiative that aimed to improve outpatients' glycemic control wasn't more successful than usual care, a new study found.

Four-hundred-and-seventy-three patients from 59 Australian primary care practices were randomized to receive usual care or a coaching intervention delivered by practice nurses without prescribing rights. All patients had type 2 diabetes, defined as hemoglobin A1c (HbA1c) >7.5% within the past 12 months. Nurses in the intervention practices were trained for two days in a phone coaching program which aimed to provide eight phone and one in-person coaching sessions per patient.

Coaching sessions dealt with lifestyle issues, medication adherence and dosing, self-monitoring and self-advocacy. In particular, the coaching program aimed to help patients learn to negotiate with physicians on intensifying their medication, if needed. The program was adapted for diabetes patients from an evidence-based intervention for patients with cardiovascular risk. The study's main outcome was HbA1c level at 18 months after baseline. Results were published Sept. 18 by BMJ.

There was no significant difference between groups in HbA1c level at 18 months follow up; there also were no significant differences in most clinical measures, though intervention patients were more likely to attain a healthy body mass index of less than 25 (P<0.03). Patient attrition rates were 5% in each group. The median number of coaching sessions for the 236 intervention patients was three, and 25% of intervention patients had no sessions. Of patients who got at least one session, the median number of sessions was four.

Nurses spent a median of 30 minutes per session to deliver coaching and craft individual action plans. Holders of health care cards (low-income patients) were more likely to receive 1 to 4 coaching sessions than non-health care card holders. Only 18% of phone calls included advice about intensifying medications, and only 70% documented current medications.

The intervention may have been more successful if the nurses had undergone a longer training period and/or if more of the intended phone sessions had been delivered, the authors wrote. “Clearly the intensity of the intervention was a problem in our study as patients who received coaching only received a median of three telephone calls despite support for the practice nurses from the research team,” they wrote. Still, the study was designed to be conducted in a real-world setting, so the fact that most patients didn't receive the intended intervention “may be best seen as an outcome rather than a limitation,” they wrote.