• Eugene Z Oddone, Jennifer M Gierisch, Linda L Sanders, Angela Fagerlin, Jordan Sparks, Felicia McCant, Carrie May, Maren K Olsen, and Laura J Damschroder.
• Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. eugene.oddone@va.gov.
• J Gen Intern Med. 2018 Sep 1; 33 (9): 148714941487-1494.

BackgroundA large proportion of deaths and chronic illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity.ObjectiveTo test whether telephone-based health coaching after completion of a comprehensive health risk assessment (HRA) increases patient activation and enrollment in a prevention program compared to HRA completion alone.DesignTwo-arm randomized trial at three sites.SettingPrimary care clinics at Veterans Affairs facilities.ParticipantsFour hundred seventeen veterans with at least one modifiable risk factor (BMI ≥ 30, < 150 min of at least moderate physically activity per week, or current smoker).InterventionParticipants completed an online HRA. Intervention participants received two telephone-delivered health coaching calls at 1 and 4 weeks to collaboratively set goals to enroll in, and attend structured prevention programs designed to reduce modifiable risk factors.MeasurementsPrimary outcome was enrollment in a structured prevention program by 6 months. Secondary outcomes were Patient Activation Measure (PAM) and Framingham Risk Score (FRS).ResultsMost participants were male (85%), white (50%), with a mean age of 56. Participants were eligible, because their BMI was ≥ 30 (80%), they were physically inactive (50%), and/or they were current smokers (39%). When compared to HLA only at 6 months, health coaching intervention participants reported higher rates of enrollment in a prevention program, 51 vs 29% (OR = 2.5; 95% CI: 1.7, 3.9; p < 0.0001), higher rates of program participation, 40 vs 23% (OR = 2.3; 95% CI: 1.5, 3.6; p = 0.0004), and greater improvement in PAM scores, mean difference 2.5 (95% CI: 0.2, 4.7; p = 0.03), but no change in FRS scores, mean difference 0.7 (95% CI - 0.7, 2.2; p = 0.33).ConclusionsBrief telephone health coaching after completing an online HRA increased patient activation and increased enrollment in structured prevention programs to improve health behaviors. CLINICALTRIALS.Gov IdentifierNCT01828567.

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