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Improving Patient-Clinician Communication About Chronic Conditions: Description of an Internet-Based Nurse E-Coach Intervention

Allen, Marybeth; Iezzoni, Lisa I.; Huang, Annong; Huang, Linchang; Leveille, Suzanne G.

doi: 10.1097/01.NNR.0000313478.47379.98

Background: Studies show that patients who have higher self-efficacy and participate actively in their care have better disease management. Patient-provider Internet portals offer an exciting new venue for empowering and engaging patients in better management of chronic conditions.

Objectives: To describe development of an Internet-based health coaching intervention.

Approach: An Internet-based health coaching intervention to enhance patient-provider communication regarding three common conditions, chronic pain, depression, and impaired mobility, was developed. Using principles of self-management, the intervention aimed to engage and empower patients to collaborate with their primary care physician in managing their health conditions. Delivered online by nurse electronic coaches (e-coaches), the intervention involved a standardized set of e-mails and worksheets targeting self-efficacy, patient education, and motivation to improve health.

Results: Participants in the intervention (N = 121) primarily used the automated elements of the program, although 35% exchanged e-mails with the nurse e-coach. Most patients (88%) who contacted the e-coach were interested in further coaching. Patients who viewed the online worksheets did so repeatedly; 42 patients opened the worksheets 107 times prior to the visit.

Discussion: The Internet-based coaching intervention departs substantially from usual nursing care but warrants further study given its potential to offer considerable benefits to large numbers of patients. Several challenges were identified to providing patient coaching and self-management support via the Internet, but this efficient and low-cost approach offers an innovative opportunity to improve patient-clinician partnerships in managing chronic conditions. As patients become more accustomed to electronic communication, nurses can play an important role, joining efforts to develop this new realm to promote patients as partners in managing their health conditions.

Marybeth Allen, BS, RN, was Lead Clinical Nurse, Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Lisa I. Iezzoni, MD, MSc, is Professor of Medicine, Harvard Medical School, Boston, Massachusetts, and Associate Director, Institute for Health Policy, Massachusetts General Hospital, Boston.

Annong Huang, MD, PhD, is Statistical Programmer, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Linchang Huang, PhD, is Developer, Applied Informatics, Information Systems Department, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Suzanne G. Leveille, PhD, RN, is Assistant Professor of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Accepted for publication September 30, 2007.

This work was supported by a grant from the Robert Wood Johnson Foundation via its Health eTechnologies Initiative. The authors would like to thank Drs. Saul Weingart and Russell Phillips for their guidance and Melissa Cote, RN for her work with the intervention.

Corresponding author: Suzanne G. Leveille, PhD, RN, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon St., Rm. 219, Brookline, MA 02446 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.