HEALTH COACHING THROUGH PERSONALIZED EHEALTH APPLICATIONS TO REDUCE THE RISK TO GET CVD FOR PATIENTS WITH HYPERTENSION

Number of patients involved: 400

The Region of Norrbotten is conducting a telemedicine study where patients with hypertension are encouraged to improve their lifestyles to reduce the risk to get CVD.

Trial set-up

The field trial is carried out at four primary healthcare centers in Norrbotten: Björknäs and Sanden in Boden, Grytnäs in Kalix and Övertorneå Healthcare Centre. The healthcare centers serve between 3,500-12,000 patients each. A large effort has been made to develop efficient cooperation among doctors, nurses, physiotherapists, biomedical analysts and receptionists. 

In order to manage the trial efficiently, two healthcare professionals at each healthcare center were trained to introduce patients to the prescribed healthcare method. This was accomplished through group education (see Figure 1). The patients received information regarding the importance of a healthy lifestyle and how it affects their disease by reducing risks for other chronic diagnoses. The patients were also informed as to how to use the prescribed healthcare web application as well as health promoting equipment such as step counters and pulse watches. They were also trained on how to use the blood pressure meter. If applicable, they were also trained on how to use a PK meter and two-channel ECG.

Figure 1: Health coaching process.

After the group education, an individualized health improvement planwas developed together with each patient. The healthcare staff specified recommended reference values for the preventive health and medically diagnosed self measurements. If applicable, alarm levels were also specified.

The patient then performed the agreed upon activities by themselves or in groups. They registered the results through MVK, a Swedish patient portal. MVK is available to all Swedish citizens and provides high security access. By intuitive graphs, patients can interpret their progress. If an alarm level is reached, the healthcare staff will take appropriate action. Otherwise, the staff will follow up with the results after the completed reporting period, which is normally six to eight weeks. The follow-up can be performed through physical meetings or video conferences. When needed, activities and/or medications are changed.

Applications and equipment

Four new web applications are used for prescribed healthcare. The web applications are provided through MVK, the Swedish patient portal:

• Treatment instructions are provided through video messages, digital images and other kinds of secure attachments.
• A prescribed healthcare schedule, personal registration and result presentation functionality. The patients register their performed preventive health and/or the medically diagnosed measurement results. Both patients and medical staff can view the progress through intuitive diagrams.
• The patients are given access to actual medication lists from the patients' electronic health record. The patient can activate an alarm to become notified when it is time to take their medication. It is also possible to register the patient's intake.
• Web-based video meetings between patients and healthcare staff are provided. 

Ninety-two percent of the Swedes have home access to the Internet. During the field trial, patients who did not have Internet access were provided with a tablet PC with mobile broadband connection. Figure 1 shows the preventive health and medical diagnosis equipment used during the field trial. All patients are provided with step meter and blood pressure meter. Pulse watch, two-channel ECG and PK meter are available if needed. Multiple diagnose patients with Diabetes also use Glucose meter.

Figure 2: Equipment used by the patients

Evaluation

Before the intervention began, the patients in the intervention and the control group answered SF36 v2, SOC-13 and EQ-5D questionnaires. Information was gathered regarding the patient's physical activity, smoking habits and alcohol consumption. Measurements were made to register blood pressure, blood lipids and body weight.

After a 12-month intervention period, the same investigation will be made to identify changes between those in the intervention and control groups.  

An economic evaluation will also be conducted considering investments, running costs and economical effects.

Expected outcomes

The aim of this study is to evaluate whether the introduction of large-scale personalized and technology supported telemonitoring and health coaching interventions produce benefits in terms of health related quality of life, health status and empowerment of patients with increased risk to get cardio vascular diagnose. In addition, the trials evaluate the economical and organizational impact of the new services and examine their acceptability by patients and health professionals.