A multidimensional integrative medicine intervention to improve cardiovascular risk

Edelman, David; Oddone, Eugene Z.; Liebowitz, Richard S.; Yancy, William S.; Olsen, Maren K.; Jeffreys, Amy S.; Moon, Samuel D; Harris, Amy; Smith, Linda L.; Wolever, Ruth Q.; Gaudet, Tracy

doi:10.1111/j.1525-1497.2006.00495.x

Cited by 113 publications

(126 citation statements)

References 34 publications

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“…Our findings are consistent with those of Edelman et al, 6 who documented increased days of exercise and greater weight loss among those who participated in PHP-IHC compared to those receiving usual care. Likewise, Wolever, et al 8 demonstrated increased patient activation, social support, and exercise frequency among patients with type II diabetes who received PHP-IHC compared to those receiving usual care.…”

Section: Discussionsupporting

confidence: 83%

Personalized Health Planning With Integrative Health Coaching to Reduce Obesity Risk Among Women Gaining Excess Weight During Pregnancy

Yang¹,

Wroth²,

Parham³

et al. 2013

Global Adv Health Med

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应用综合健康辅导的个性化健康计划降低女性在怀孕过程中超重的肥胖风险Plan sanitario personalizado con formación de salud integradora para reducir el riesgo de obesidad entre las mujeres con un aumento de peso excesivo durante el embarazo ABStRACtHealth coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHP-IHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women. SINOPSISLa formación de salud es una nueva intervención conductual para mejorar los resultados en la prevención y el tratamiento de la enfermedad crónica; sin embargo, ningún estudio ha examinado su utilidad en las mujeres puérperas que han aumentado excesivamente de peso durante el embarazo. Una mujer primigesta de 32 años de edad que presentaba sobrepeso en el momento de la concepción y había engordado 10,5 kg más que las recomendaciones establecidas por el Instituto de Medicina (IOM, por sus siglas en inglés) para su índice de masa corporal previo al embarazo participó en un plan sanitario de 6 meses de duración con una intervención de formación de salud integradora (PHP-IHC, por sus siglas en inglés). La intervención incluyó una revisión de evaluación basal del riesgo para la salud con un profesional sanitario y 8 sesiones telefónicas de formación de salud de 30 minutos de duración cada quince días. La participante demostró mejorías en la actividad física, el consumo de energía, el conocimiento y en la confianza a la hora de implicarse en comportamientos que favorecían su salud. A pesar de que la participante no logró alcanzar el peso objetivo al finalizar las sesiones de formación de salud, una visita de seguimiento 8 meses después confirmó que lo había alcanzado (dentro del 5 % del peso previo al embarazo). Este caso clíni-co sugiere que el PHP-IHC puede ayudar a las mujeres puérperas a recuperar el peso previo al embarazo tras el aumento de peso excesivo durante la gestación. Se nec...

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Section: Discussionsupporting

confidence: 83%

Personalized Health Planning With Integrative Health Coaching to Reduce Obesity Risk Among Women Gaining Excess Weight During Pregnancy

Yang¹,

Wroth²,

Parham³

et al. 2013

Global Adv Health Med

View full text Add to dashboard Cite

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“…For example, although only emerging in the past decade, one brand of integrative health coaching has been well described, standardized within a framework that allows for individual tailoring, 87,88 and shown to be effective. 17,21,93,94 Perhaps the best example of standardization of individually tailored processes is seen in motivational interviewing; the MI processes have been well described, standardized within a framework, widely disseminated, and demonstrated to be effective in many settings. 9,78,79,90,[95][96][97] Moreover, motivational interviewing has the advantage of several psychometrically sound program evaluation measures (eg, Motivational Interviewing Skills Code, 98 Motivational Interviewing Treatment Integrity 99 ) that can be used to ensure intervention integrity and assess intervention outcomes for common threats to validity.…”

Section: Individualized Vs Protocol-driven Coachingmentioning

confidence: 99%

A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare

Wolever¹,

Simmons²,

Sforzo³

et al. 2013

Global Adv Health Med

109

206

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Primary Objective: Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature. Background: As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches. Results: Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patientdetermined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills. Conclusions: Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goalsetting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease. 摘要

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“…Other CVD primary prevention studies achieved larger effects but required greater resources, and many included multiple contacts with clinicians. 8,10,11,[21][22][23][24] If a measurable positive effect of a more limited intervention like ours can be accomplished at a sufficiently low cost, it may be a worthwhile approach to adopt. If the process of delivering these messages can be fully automated (such as using a patient portal connected to the electronic health record), this may reduce the cost of providing this service further.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies with repeated exposure to risk messages and counseling have shown the most favorable results. 8,10,11,22,23 An additional study is needed to examine whether repeated delivery increases efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…There is some evidence that primary prevention approaches that use calculation of CVD risk lead to increased treatment of risk factors by physicians, and can increase patients' intent to start therapies, such as lipid-lowering medication or aspirin, by about 15 to 30 %. [7][8][9][10][11][12][13] Data contained in an electronic health record (EHR) can be used to identify candidates for risk-reducing interventions. 14,15 Automated identification of these patients makes possible practice-wide quality improvement activities delivered directly to patients, such as the approach we tested here.…”

Section: Introductionmentioning

confidence: 99%

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Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

et al. 2012

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BACKGROUND: Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness. OBJECTIVE AND DESIGN: To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care. PARTICIPANTS: Patients of participating physicians with a Framingham Risk Score of at least 5 %, lowdensity lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis. INTERVENTION: Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant). MAIN MEASURES: The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311. KEY RESULTS: Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P=0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1. 05-4.32, p=0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P=0.029). CONCLUSIONS: In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention's effect on LDL-cholesterol levels was apparent.

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A multidimensional integrative medicine intervention to improve cardiovascular risk

Abstract: A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.

Cited by 113 publications

References 34 publications

Personalized Health Planning With Integrative Health Coaching to Reduce Obesity Risk Among Women Gaining Excess Weight During Pregnancy

Personalized Health Planning With Integrative Health Coaching to Reduce Obesity Risk Among Women Gaining Excess Weight During Pregnancy

A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

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