He Application Of E-Coach Chronic Care Model In Management Of Hypertension Patients

ObjectivesTo establish E-Coach chronic care model from hospital to home,which is based on integrating the traditional Health coaching technology with the Internet and the self-developed APP and wearable devices for chronic disease management,and to observe its feasibility and effects in patients with hypertension.MethodsPart I: The E-Coach chronic care model were established by literature review and experts focus group interviews.This paper expounds the framework,organizational structure,implementation steps,process objectives and implementation methods of E-Coach chronic care model.Compared with the traditional Health coaching technology,the innovation characteristics and implementation difficulties of the model are analyzed.Part II: A total of 232 hypertensive patients in a tertiary hospital in Chongqing were selected and randomly divided into experimental group(n=116)and control group(n=116).On the basis of routine hospital outpatient management model,the experimental group was intervened byE-Coach chronic care model,while the control group was intervened by routine outpatient management for 6 months.The changes of blood pressure control rate,medication quantity and compliance,participation rate of off-line chronic disease management activities and self-management behavior were compared and analyzed between the two groups at baseline and after 6 months intervention.Results1 E-Coach chronic care model was constructed.The theoretical basis of the model is Orim's self-care theory.The carriers of E-Coach care model are wearable device and "Juyue Health APP" which was developed by the research group in the early stage.The basic tool is the nursing procedure.The implementation process is eight steps of "COACHING"(Contact,Observe,Affirm,Clarify,Help,Inspire,Nurture,Guide).The specific composition of E-Coach chronic care model is mainly composed of model framework,team structure and members' responsibilities,implementation steps,implementation objectives and methods.2 The clinical application of this model in patients with hypertension is as follows: 1)In the aspect of blood pressure control,the blood pressure control rate of E-Coach chronic care model group increased from 27.5%before intervention to 61.8% after intervention,which was significantly higher than that of traditional outpatient management group(44.9%,P <0.05);after intervention,the systolic blood pressure of experimental groupdecreased more than that of control group(14.0 mmHg VS.8.0 mmHg),and the difference was statistically significant(P < 0.05);2)In the terms of Compliance with medication,after the intervention,48.0% of patients in E-Coach group had good drug compliance,and 42.9% of patients in the control group.The patients with moderate compliance in E-Coach group was 31.4%,and the control group was 32.7% respectively.Compliance score of E-Coach group increased by 0.8 points compared with baseline,while that of control group increased by 0.5 points compared with baseline.There was no statistical difference in compliance evaluation between the two groups(P > 0.05).3)The participation rate of two groups of offline chronic disease management activities was compared: During the six-month intervention period,the actual number of participants in the E-Coach group's off-line lecture on chronic disease management knowledge was 109,the total number of participants should be 150,the participation rate was 72.7%.The actual number of participants in the control group was 53,and the total number of participants was 150.The participation rate was 35.3%.4)In terms of self-management behavior,the average weekly aerobic exercise time of the experimental group was 97.5±73.2 minutes per week,which was 48.5±18.2 minutes per week higher than that before intervention(baseline time),compared with the control group which was 20.5 ± 8.6 minutes per week,the difference was statistically significant(P < 0.05).After the intervention,the scores ofcognitive symptoms management and communication with doctors in the experimental group were increased by 0.7 ± 0.2 points and 1.7 ± 0.5points,respectively,which were higher than those in the control group(0.2±0.1 and 0.9±0.1),with statistical significance(P < 0.05).ConclusionsBased on Orem's self-care theory,the E-Coach chronic care model constructed in this study conforms to the current situation of modern people's extensive application of smart phones.It optimizes and integrates the Internet,Internet of Things technology and the traditional Health coaching technology confirmed by evidence-based practice,and innovates the traditional Health coaching and hypertension management model.In this study,E-Coach chronic care model was applied to patients with essential hypertension.The results show that this optimization makes up for the disadvantages of traditional Health coaching technology,can effectively improve the self-management behavior of patients with hypertension,improve the control rate of blood pressure and the participation rate of off-line chronic disease management activities,and construct a continuous and standardized management service for patients with hypertension from discharge to home.The model deserves further study and promotion.