Approach to Antihypertensive Adherence: A Feasibility Study on the Use of Student Health Coaches for Uninsured Hypertensive Adults

Abstract

Background Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management. Methods Medical, nursing and pharmacy students (n = 11) were recruited and trained as health coaches for uninsured, hypertensive patients (n = 25) of a free clinic in an uncontrolled open trial. Pre-post analysis was conducted on BP, medication adherence, frequency of home BP monitoring, and healthy behavior (e.g., diet, exercise). Patient satisfaction and feasibility of a student coach model was qualitatively evaluated. Results In the 12 patients who completed the intervention, an increase in medication adherence as measured by the Brief Medication Questionnaire was observed (P < 0.01), with a 11 mmHg reduction in systolic BP (P = 0.03). Qualitative data showed patient satisfaction with the intervention and other healthy behavior change. Conclusions This feasibility study shows use of student health coaches to combat medication non-adherence in uninsured, hypertensive adults is promising.

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

“…At the least intensive end, only 1.5 hours of training were provided to content experts in weight loss and consisted of the rationale for health coaching 62 or 2 hours of coaching-specific training were provided to MD, PharmD, or RN student health coaches to support uninsured patients with hypertension. 63 At the most intensive end, a 9-month curriculum was provided to medical assistants to coach patients with chronic health issues, 64 and an estimated 600 hours of training were provided to non-medical professionals to help newly diagnosed cancer patients navigate the healthcare system and their treatment. Greater than 6 wk (eg, 1 y experience plus CDE training, 600 h, ICF certification required) 5…”

Non-Adherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

“…Twenty-four studies were cross-sectional [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and others were cohort, [35] observational, [36] and interventional studies. [32] Only 1 randomized controlled trial (RCT) was found. [29] The sample size of studies ranged from 25 [32] to 2445 [21] subjects.…”

“…Nine of the studies were conducted in the United States, [11,12,15,26,29,30,32,33,35] and 2 each in China, [11,17] Nigeria, [16,22] Hong Kong, [21,25] and Iran. [10,18] Countries such as Uganda, Lebanon, Kenya, Republic of Korea, Peru, Ethiopia, Ghana, Malaysia, Palestine, Brazil, and Italy were represented with a single study.…”

“…[9,11,12,15,16,19,27,28] Except 1 study, [22] all the included studies met the quality criteria and showed high quality (>75%). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36] …”

“…[29] The sample size of studies ranged from 25 [32] to 2445 [21] subjects. Eleven studies assessed adherence through face-to-face interviews, [10,14,18,20,[22][23][24]26,[29][30][31] while 8 studies used selfadministered questionnaires, [13,17,21,25,[32][33][34]36] and only 1 study was administered through a telephone interview. [35] However, 8 studies did not specify the type of MMAS-8 questionnaire administered.…”