Telephone Intervention Improves Cardiovascular Risk Factors
Three modifiable risk factors (tobacco use, overweight/obesity, and physical inactivity) are linked to more than half of all preventable deaths and many illnesses. Addressing these risk factors is particularly important for Veterans, more than 70% of whom are overweight, 40% of whom are obese, and 30% of whom smoke. Health risk assessment (HRA) is a comprehensive method to elicit patient reported behaviors – and combine them with clinical values – to show patients their risk for adverse outcomes, and the degree to which that risk can be lessened by changing their behaviors. This randomized controlled trial assessed the effectiveness of an HRA coupled with a brief health coaching intervention to encourage Veterans to enroll and participate in a prevention program chosen based on their needs and preferences. From primary care clinics at three VAMCs, 417 Veterans with at least one modifiable cardiovascular risk factor (smoker, overweight or obese, <150 minutes of at least moderate physical activity per week) were recruited from 11/14 through 5/16. After completing an online HRA, Veterans in the intervention group received two telephone-based health coaching calls at one and four weeks to set goals to enroll in and attend prevention programs designed to reduce their risk. The HRA was developed by VA's National Center for Health Promotion and Disease Prevention and launched nationally through MyHealtheVet in 2014.The primary study outcome was enrollment in a structured prevention program by six months. Secondary outcomes included scores on the Patient Activation Measure (PAM), which evaluates Veterans' knowledge, willingness, and confidence in managing their health, as well as the Framingham Risk Score (FRS), which assesses cardiovascular risk.
- Brief telephone health coaching increased patient activation and increased enrollment in structured prevention programs to improve health behaviors among Veterans at cardiovascular risk.
- From baseline to six months, compared to controls, Veterans participating in the intervention reported higher rates of enrollment in a prevention program (51% vs 29%) and higher rates of program participation (40% vs 23%).
- Compared to controls, intervention participants also had greater improvement in PAM scores, but no changes in FRS scores.
- The authors suggest that next steps should concentrate on how best to incorporate this relatively low resource-intensive intervention for cardiovascular risk into routine primary care practice and/or tele-coaching services.
- The primary outcome, enrollment in a prevention program, was determined by patient self-report.
- Enrollment of Veterans engaged in MyHealtheVet may not fully represent those not using this portal.
- The six-month study duration may not have been long enough to experience benefits in risk as computed by the FRS.
Oddone E, Gierisch J, Sanders L, et al. A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: A Randomized Controlled Trial. Journal of General Internal Medicine. May 7, 2018;e-pub ahead of print.