Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

Margolius, David; Bodenheimer, Thomas; Bennett, Heather; Wong, Joseph; Ngo, Victoria; Padilla, Guillermo Zermeño; Thom, David H.

doi:10.1370/afm.1369

Cited by 90 publications

(123 citation statements)

References 19 publications

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“…These findings are consistent with those of previous randomized controlled trials showing positive benefits for other models of self-management support using peers, registered nurses, or community health workers. [32][33][34][35] Health coaching did not improve control of hypertension 32,39 We found site-related differences in outcomes. Significant clinical improvements were seen with coaching at the larger site A, but not at site B.…”

Section: Discussionmentioning

confidence: 81%

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

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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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Section: Discussionmentioning

confidence: 81%

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

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131

132

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“…A randomized clinical trial by Margolis and colleagues 5 fi nds that home blood pressure monitoring and weekly health coaching are associated with reduced blood pressure in low-income minority patients with poorly controlled hypertension, but it fi nds no effect of home titration of blood pressure medications.…”

Section: Understanding and Improving Care For Vulnerable Peoplementioning

confidence: 99%

In This Issue: From Communities of Solution to Joy

Stange¹

2012

The Annals of Family Medicine

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“…Health coaching has been proposed as an inexpensive and effective means to improve control of chronic conditions 1 and has been effective in improving management of diabetes and other risk factors for cardiovascular disease, asthma, and chronic obstructive pulmonary disease. 4,5,9,10,[17][18][19] Coaches may be particularly valuable in resource-poor settings, where minority and low-income communities bear a disproportionate burden of chronic disease and its complications, and are less likely to engage in effective self-management of their conditions. 20 In these settings, clinics can often employ coaches who culturally and linguistically match the patients' characteristics.…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

Thom

Wolf

Gardner

et al. 2016

The Annals of Family Medicine

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PURPOSE Although health coaches are a growing resource for supporting patients in making health decisions, we know very little about the experience of health. We undertook a qualitative study of how health coaches support patients in making decisions and implementing changes to improve their health. METHODSWe conducted 6 focus groups (3 in Spanish and 3 in English) with 25 patients and 5 friends or family members, followed by individual interviews with 42 patients, 17 family members, 17 health coaches, and 20 clinicians. Audio recordings were transcribed and analyzed by at least 2 members of the study team in ATLAS.ti using principles of grounded theory to identify themes and the relationship between them. RESULTSWe identified 7 major themes that were related to each other in the final conceptual model. Similarities between health coaches and patients and the time health coaches spent with patients helped establish the health coachpatient relationship. The coach-patient relationship allowed for, and was further strengthened by, 4 themes of key coaching activities: education, personal support, practical support, and acting as a bridge between patients and clinicians. CONCLUSIONSWe identified a conceptual model that supports the development of a strong relationship, which in turn provides the basis for effective coaching. These results can be used to design health coach training curricula and to support health coaches in practice. Ann Fam Med 2016;14:509-516. doi: 10.1370/afm.1988. INTRODUCTIONR ecent efforts to provide more integrated, patient-centered primary care have included patient activation, patient education and engagement, shared decision making, and self-management support. Health coaches work in all of these areas, providing patients with health-related information, navigational support, connections to community resources, and personal support.1,2 Coaches focus on helping patients to identify goals, create plans to make changes, and implement changes. Although health coaching can be performed by licensed professionals including nurses, physical therapists and respiratory therapists, 3,4 or by other patients (peer support), 5-8 medical assistants 1,9,10 and other unlicensed health workers (eg, community health workers, lay health advisers, and promotoras) [11][12][13][14][15][16] are emerging as a common and relatively economical workforce that may meet the demand for self-management support. Health coaching has been proposed as an inexpensive and effective means to improve control of chronic conditions 1 and has been effective in improving management of diabetes and other risk factors for cardiovascular disease, asthma, and chronic obstructive pulmonary disease. 4,5,9,10,[17][18][19] Coaches may be particularly valuable in resource-poor settings, where minority and low-income communities bear a disproportionate burden of chronic disease and its complications, and are less likely to engage in effective self-management of their conditions. 20 In these settings, clinics can often employ coaches wh...

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Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

Cited by 90 publications

References 19 publications

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

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

In This Issue: From Communities of Solution to Joy

A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

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