Evaluating a Culturally and Linguistically Competent Health Coach Intervention for Chinese-American Patients With Diabetes

Ivey, Susan L.; Tseng, Winston; Kurtovich, Elaine; Weir, Rosy Chang; Liu, Jing; Song, Hui; Wang, May D.; Hubbard, Alan

doi:10.2337/diaspect.25.2.93

Cited by 33 publications

(35 citation statements)

References 31 publications

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“…31 In addition, providing financial incentives or paths to career advancement for MAs can help to overcome reluctance on their part and increase MA retention. 13 Finally, dissemination of lessons learned and strategies used are needed to enable other primary care practices to expand MA roles more smoothly and efficiently.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, Ferrer and colleagues 2 found that there was poor adoption of MA health coaching, and several randomized trials testing the effects of MA diabetes health coaches found no significant differences in hemoglobin A1C levels or hospitalizations between control and intervention group patients. 10,13,15,18 There is currently a limited understanding as to why there was success in some studies and not others.…”

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confidence: 99%

“…5 They also serve as health coaches to improve lifestyle behaviors 9 , chronic disease care processes 3,10 -18 , and medication adherence. 19 These innovative MA roles have been reported across diverse settings, including private practices 2,3,5,20 , community health centers 5,10,13,15,16,19 , academic primary-care practices 8,9,12,14 , rural practices 17 , and large health care systems. 4,5,7 Outcomes in studies that have focused on or included MA role expansion or innovation have varied.…”

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confidence: 99%

“…10,[13][14][15][16] To our knowledge, only 3 studies have specifically evaluated MAs' expanding roles in the broader context of primary-care transformation projects.…”

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confidence: 99%

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Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

et al. 2018

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Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes.Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory.Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

“…10,[13][14][15][16] To our knowledge, only 3 studies have specifically evaluated MAs' expanding roles in the broader context of primary-care transformation projects.…”

mentioning

confidence: 99%

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Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

et al. 2018

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“…[16][17][18][19] Medical assistant health coaching could be a viable model for providing self-management support in primary care if its effectiveness were demonstrated across the most prevalent cardiovascular conditions. We conducted a randomized controlled trial to test the effectiveness of clinic-based medical assistant health coaching vs usual care to improve clinical indicators among low-income patients with uncontrolled type 2 diabetes, hypertension, and hyperlipidemia.…”

Section: Introductionmentioning

confidence: 99%

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Willard-Grace

Chen

Hessler

et al. 2015

The Annals of Family Medicine

131

132

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PURPOSE Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care. METHODSWe conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California. The primary outcome was a composite measure of being at or below goal at 12 months for at least 1 of 3 uncontrolled conditions at baseline as defined by hemoglobin A 1c , systolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Secondary outcomes were meeting all 3 goals and meeting individual goals. Data were analyzed using χ 2 tests and linear regression models.RESULTS Participants in the coaching arm were more likely to achieve both the primary composite measure of 1 of the clinical goals (46.4% vs 34.3%, P = .02) and the secondary composite measure of reaching all clinical goals (34.0% vs 24.7%, P = .05). Almost twice as many coached patients achieved the hemoglobin A 1c goal (48.6% vs 27.6%, P = .01). At the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (41.8% vs 25.4%, P = .04). The proportion of patients meeting the systolic blood pressure goal did not differ significantly.CONCLUSIONS Medical assistants serving as in-clinic health coaches improved control of hemoglobin A 1c and LDL levels, but not blood pressure, compared with usual care. Our results highlight the need to understand the relationship between patients' clinical conditions, interventions, and the contextual features of implementation. 2015;13:130-138. doi: 10.1370/afm.1768. Ann Fam Med INTRODUCTIONC ardiovascular disease is the leading cause of death in the United States, 1 and it accounts for more than $500 billion of health care spending annually.2 Despite the demonstrated effectiveness of pharmaceutical therapies and lifestyle modifications for improving cardiovascular disease outcomes, 50% of people with hypertension, 43% with diabetes, and 80% with hyperlipidemia have not reached their goals for blood pressure, glycemic control, or lipids, respectively. [3][4][5] One-half of patients do not take their chronic disease medications as prescribed, and only 1 in 10 patients follow recommended guidelines for lifestyle changes, such as smoking cessation or weight loss. 6 Minority and low-income communities bear a disproportionate burden of chronic disease and its complications, 7 and they are less likely to engage in effective self-management of their conditions. 8,9 Contributors to this gap in self-management include a lack of patient understanding of, and agreement with, the care plan, and low confidence and motivation to make healthy choices. or were not designed as randomized trials.17-19 They focused on a single condition such as diabetes or hypertension. [16][17][18][19] Medical assistant health coa...

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Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus

Attridge

Creamer

Ramsden

et al. 2014

Cochrane Database of Systematic Reviews

146

154

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Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.

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Evaluating a Culturally and Linguistically Competent Health Coach Intervention for Chinese-American Patients With Diabetes

Cited by 33 publications

References 31 publications

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus

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