Hey, doctors! What does your patient actually need between appointments?

Digital support, self-management, health coaching and team-based care; where does each fit?

There is a moment in healthcare that deserves rather more attention.

It happens after the consultation and many doctors have though at providing patients with digital support or cross-related appointments.

The diagnosis has been explained. The treatment plan has been agreed. The patient has perhaps been told to increase physical activity, change their diet, stop smoking, lose weight, monitor their blood pressure or find ways to manage their condition more effectively.

This is where the interesting part begins.

Because health recommendations don't exist in isolation. They have to fit around work, children, caring responsibilities, pain, fatigue, food preferences, finances, habits, confidence, relationships and everything else that was happening before the consultation took place.

Healthcare has become increasingly good at giving people information. It is also becoming increasingly sophisticated at keeping people connected to that information once they leave the consulting room. Apps can remind patients about medication, record measurements, provide educational material, monitor symptoms and activity, and sometimes connect patients with their healthcare team.

These developments matter. Digital health has an important role to play in extending healthcare beyond the traditional appointment, and the World Health Organization now explicitly recognises digital technologies as part of the infrastructure that can support self-care.

There is a distinction worth making though:

Giving someone more access to support isn't necessarily the same as giving them the support they need.

Here the conversation about digital support, self-management, health coaching and team-based care becomes much more interesting.

The patient doesn't stop being a patient when the appointment ends

Imagine a patient who has just been told they need to become more active.

The clinician has good reason for making the recommendation. The patient understands it. They may even agree enthusiastically and an app could now become part of the picture. It might provide a walking target, count steps, send reminders and show progress over time. For some people, that may be exactly what they need.

For someone else, the problem may be completely different and the App a triggering tool that make everything worse.

Who listens if they have persistent pain and are worried that exercise will make it worse or perhaps they are exhausted and cannot see where another commitment fits into their week. Perhaps “exercise more” sounds simple in a consultation but becomes remarkably vague once they are standing in their kitchen wondering what to do on a wet Tuesday evening.

The technology can record what happened.

It may not be able to understand all the rest leaving a person feeling even more alone, incompetent with no other choice than finding another unhelpful coping mechanism.

Ok, no apps, just auto-discipline based on the doctor recommendation. Well, that distinction matters because self-management is not simply about having the right information available. The WHO describes self-care as something people do with or without support from health and care workers, while also emphasising that some people need more guidance before they can manage independently. Its European guidance on therapeutic patient education similarly describes self-management support as a structured, person-centred process that helps people develop the capacity to manage their health over time.

In other words, independence doesn't necessarily mean being left alone.

Sometimes the route to becoming more confident in managing your health involves having somebody alongside you while you learn how to do it.

So, are apps actually useful?

Yes. But the evidence is more nuanced than the technology industry sometimes makes it sound.

A large 2026 systematic review and meta-analysis of 55 randomised controlled trials involving almost 5,900 people with chronic conditions found that digital health interventions could improve some aspects of self-care, particularly self-care monitoring in heart failure. But the findings were much less convincing for broader behavioural maintenance and medication adherence and the overall certainty of evidence was often low or very low.

That doesn't mean apps don't work.

A digital platform can be extraordinarily useful when the task is monitoring, recording, prompting, communicating or making information accessible. A 2025 systematic review of digital platforms for chronic disease management found that many interventions were associated with improvements reported by patients in areas such as health, quality of life and self-management, while healthcare professionals also reported benefits for communication and clinical utility. At the same time, the authors highlighted an important limitation: many of the studies were short-term pilots, and long-term outcomes remained uncertain.

There is another detail here that I find particularly important.

Digital support tends to work better when it is not simply something patients are expected to use on their own.

A recent systematic review examining person-centred care in digital interventions found that some of the most consistent benefits came when technology was used to support self-monitoring, two-way communication, coaching and collaboratively developed care plans. The evidence was strongest for things such as engagement, empowerment and the experience of receiving care, while evidence for sustained clinical outcomes was more mixed.

That starts to point us towards something bigger.

The human part of behaviour change

This is where health coaching becomes particularly relevant.

Health coaching isn't another way of giving somebody health information. In a good coaching relationship, the patient remains the expert in their own life while the coach helps them explore what they want to change, what is getting in the way and how they might move forward.

That can sound deceptively simple. In practice, it can be the difference between a recommendation remaining an intention and becoming something somebody actually does.

A systematic review and meta-analysis published in Patient Education and Counseling in 2023 looked at randomised trials of health and wellness coaching in chronic illness care. The authors found improvements in quality of life and self-efficacy, alongside improvements in depression, although they also emphasised that the evidence was heterogeneous. Health coaching isn't a magic intervention. It isn't appropriate for every patient, and certainly it must be introduced in the right phase of readiness to change.

What it can offer is time and attention directed specifically towards the behavioural part of healthcare. A clinician may identify that a patient needs to lose weight, become more active, stop smoking or improve their diet. A coach can spend time understanding what that recommendation actually means in the person's life.

That conversation might uncover something clinically relevant, too.

A patient who repeatedly says they cannot exercise may not lack motivation. They may be frightened of worsening their pain.

Someone who cannot maintain dietary changes may not lack discipline. Their eating pattern may be deeply connected to work, stress, family routines or years of using food as a coping strategy.

Someone who keeps returning to smoking may understand the health consequences perfectly well. The cigarettes may have become stress response and sense of reward to cope with something much deeper and a conversation with a certified health coach may be easier than starting other modalities.

The behaviour is visible.

The reason underneath it often isn't, and this is one of the places where human support has something technology cannot easily replicate: the ability to explore the individual context behind the behaviour and adapt the conversation as that context changes.

Perhaps we shouldn't be choosing between digital and human support

This is where I think the conversation becomes more useful for healthcare professionals.

It isn't really a competition between the app and the coach.

Nor should health coaching be presented as the answer to every problem.

The more interesting possibility is that these forms of support can have different jobs.

Technology can extend access and continuity. It can help people monitor themselves and give clinicians useful information between appointments.

Self-management support can help patients develop the knowledge, skills and confidence to take a more active role in their health.

Health coaching can provide the human behavioural support that helps someone translate a recommendation into something workable in their circumstances.

In an ideal world, a team-based care can bring those different forms of expertise together rather than expecting one professional to do everything. Collaboration is key.

That last point is particularly relevant as healthcare increasingly manages long-term and lifestyle-related conditions.

The traditional model of a patient seeing one clinician for a relatively short appointment was never designed to contain every aspect of living with a chronic condition. The clinical consultation remains essential but there is a considerable amount of healthcare work that happens outside it: learning, practising, adjusting, noticing patterns, building confidence and trying again after something doesn't work.

What might that look like in practice?

Imagine a patient leaving a consultation with a clear clinical plan.

The clinician remains responsible for the clinical decisions.

The patient has access to a digital platform where appropriate, perhaps to monitor progress, receive information, record relevant measures or stay connected to the service and alongside that, where the patient would benefit from it, a health coach provides human structured behavioural support.

The coach doesn't reinterpret the diagnosis or change the treatment plan.

Instead, they help the patient work out how to live it. The patient might arrive at the first coaching conversation saying:

“I know what I need to do. I just can't seem to do it.”

That sentence is often treated as evidence that the patient isn't sufficiently motivated but if a skilled coach can help finding aspects of their lives contributing to the physiological response then the person can see it differently.

It can be an invitation to investigate, co-explore what has made it difficult? What have they already tried? What happens when they succeed for a while and then stop? What does a realistic version of the recommendation look like? What would make the change easier to repeat? and perhaps most importantly, what does the patient believe about themselves in relation to the change they are trying to make?

This is the part of healthcare that can easily disappear between the treatment plan and the next appointment.

The Ciao Change perspective

I don't think healthcare needs to choose between digital support, longer appointments, self-care and human support.

I think we need to become better at understanding which kind of support a patient needs, and when.

Some patients will benefit enormously from an app. Some will become more confident through structured self-management support. Some need the expertise of several healthcare professionals working together. And some need a person beside them who has the time and skills to help turn a clinical recommendation into something they can actually live with.

Often, it will be a combination.

That is where I see health coaching fitting into clinical care.

Not as another layer of treatment competing with the clinician, but as a behavioural support layer that can sit alongside it.

Patients live in homes, families, workplaces and communities. They have good weeks and difficult weeks. They get tired. They lose confidence. They have setbacks. Their circumstances change.

People have to live their healthcare recommendations.

At Ciao Change, my role is to help bridge that space between the clinical recommendation and everyday life working alongside healthcare professionals to provide structured, personalised behavioural support when a patient needs more than information alone.

Good clinical care gives people the knowledge, diagnosis and treatment they need.

Sometimes, the next step is making sure they aren't left to work out the rest on their own.

Sources and further reading

Longhini J, Pedrotti D, Foladori F, et al. (2026). Effectiveness of Digital Health Interventions to Improve Self-Care in Patients With Chronic Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Medical Internet Research. DOI: 10.2196/88708.

Howick J, et al. / relevant systematic review evidence (2023). The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Education and Counseling. DOI: 10.1016/j.pec.2023.107975.

World Health Organization (2026). Self-care for health and well-being. WHO, 3 June 2026.

World Health Organization (2024). Implementation of self-care interventions for health and well-being: guidance for health systems. WHO.

World Health Organization Regional Office for Europe (2023). Therapeutic patient education: an introductory guide. 

World Health Organization (2024). Going digital for noncommunicable diseases: the case for action. 

Longhini J, et al. (2025). Systematic review exploring human, AI, and hybrid health coaching in digital health interventions: trends, engagement, and lifestyle outcomes. Frontiers in Digital Health. DOI: 10.3389/fdgth.2025.1536416.

Digital Health Interventions to Support Chronic Disease Management: Systematic Scoping Review (2025). Evidence examining how digital platforms are being used to support chronic-disease self-management and communication between patients and healthcare providers.

 "Disclaimer: This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of Ciao Change Ltd unless specified under “The Ciao Change perspective” section."