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Health Coaching via an Internet Portal for Primary Care Patients With Chronic Conditions: A Randomized Controlled Trial

Leveille, Suzanne G. PhD, RN*†; Huang, Annong MD*; Tsai, Stephanie B. MA*; Allen, Marybeth RN, BSN*; Weingart, Saul N. MD, PhD†‡; Iezzoni, Lisa I. MD, MSc*†§

doi: 10.1097/MLR.0b013e3181844dd0
Original Article

Background: Efforts to enhance patient-physician communication may improve management of underdiagnosed chronic conditions. Patient internet portals offer an efficient venue for coaching patients to discuss chronic conditions with their primary care physicians (PCP).

Objectives: We sought to test the effectiveness of an internet portal-based coaching intervention to promote patient-PCP discussion about chronic conditions.

Research Design: We conducted a randomized trial of a nurse coach intervention conducted entirely through a patient internet-portal.

Subjects: Two hundred forty-one patients who were registered portal users with scheduled PCP appointments were screened through the portal for 3 target conditions, depression, chronic pain, mobility difficulty, and randomized to intervention and control groups.

Measures: One-week and 3-month patient surveys assessed visit experiences, target conditions, and quality of life; chart abstractions assessed diagnosis and management during PCP visit.

Results: Similar high percentages of intervention (85%) and control (80%) participants reported discussing their screened condition during their PCP visit. More intervention than control patients reported their PCP gave them specific advice about their health (94% vs. 84%; P = 0.03) and referred them to a specialist (51% vs. 28%; P = 0.002). Intervention participants reported somewhat higher satisfaction than controls (P = 0.07). Results showed no differences in detection or management of screened conditions, symptom ratings, and quality of life between groups.

Conclusions: Internet portal-based coaching produced some possible benefits in care for chronic conditions but without significantly changing patient outcomes. Limited sample sizes may have contributed to insignificant findings. Further research should explore ways internet portals may improve patient outcomes in primary care. ClinicalTrials.gov registration NCT00130416.

From the *Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center; †Department of Medicine, Harvard Medical School; ‡Center for Patient Safety, Dana Farber Cancer Institute; and §Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts.

Supported by grants from the Robert Wood Johnson Foundation (RWJF) Health e-Technologies Initiative grant 051757.

This trial was registered at ClinicalTrials.gov, identifier: NCT00130416.

This study was approved by the Beth Israel Deaconess Medical Center Institutional Review Board, January 2005.

Reprints: Suzanne Leveille, PhD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon St CO-219, Brookline, MA 02446. E-mail: sleveill@bidmc.harvard.edu.

© 2009 Lippincott Williams & Wilkins, Inc.