Health Coaching: A trend to watch in health care

In a survey of 1,015 consumers, (Televox, 2011) 83% said they did not follow treatment plans exactly as prescribed, but said they’d do a better job following doctors’ orders if doctors checked up on them between visits. Forty-two percent said they would follow the treatment plan better if they got encouragement between visits, and 35% said they’d do better if they got reminders to do specific things, like take their medicine, by email, voicemail, or text.

In the same study only 25% of more than 2,200 healthcare providers said they believe it’s their job to keep patients on track between office visits. Yet, these providers also believe that most patients would become more treatment compliant with motivation and coaching.

So, in general, our medical support is not matching real needs or evidence. We have hit the wall of non-adherence. Medications and other treatments get research funding, but can be less effective then predicted when they are not used as directed.

We have an evidence-based, effective solution, but we rarely apply it. Patient education has two parts: (1) information sharing, and (2) health coaching, which is helping patients change behaviors based on this new information. Coaching is one-on-one assistance with problem-solving, using open-ended questions, affirmation of strengths, and reflective listening. Many studies show health coaching can positively impact self-care behaviors and improve health outcomes.

For example, a randomized clinical trial of 56 patients with type 2 diabetes compared usual care to an intervention of individualized integrative health coaching that focused on patients’ values and sense of purpose. They found health coaching significantly reduced their A1C, and produced self-reported improvements in adherence, exercise frequency, stress, and perceived health status. (Wolever, Dreusicke, et al., 2010)

Sperl-Hillen and Beaton, et al. (2011) found in a randomized study that individual education for patients with established suboptimally-controlled diabetes resulted in better glucose control outcomes than the usual care group education. Those with individual education also trended toward better psychosocial and behavioral outcomes.

Sacks (2011) found that telephone coaching can be as effective as in-person counseling for weight loss, and Terry and Seaverson, et al. (2010) found telephone and mail programs can be effective in reducing participants’ health risk status, though the telephone program was slightly more effective.

One Family Health Center published their experiences implementing an approach where each physician teamed with a health coach to help manage patients with chronic conditions, calling the pair a teamlet. (Ngo, Hammer, et al., 2010). They found it to be beneficial, and suggested that primary care sites—whether community health centers, private offices or teaching clinics—consider incorporating the teamlet concept into their care model.

We readily prescribe medications that cost thousands of dollars per treatment course — or even dose — yet do not fully take advantage of effective interventions that involve human relationships and support. Health coaching not only improves health outcomes, it offers employment to health care providers, with the potential of improving our economy through jobs.

On the other hand, data from the U.S. Health and Retirement Study shows long term improvement in behavior change is hard, and intensive efforts are required to help initiate and maintain lifestyle improvements in the chronically ill (Newsom, Huguet, et al., 2011). Health coaching may not always be a short-term intervention. We have a lot of work ahead.

© (2011) Fran London, MS, RN

Resources:

Newsom, J. T., Huguet, N., et al. (2011). Health Behavior Change Following Chronic Illness in Middle and Later Life. J Gerontol B Psychol Sci Soc Sci. [Epub ahead of print]

Ngo, V., Hammer, H. et al. (2010). Health coaching in the teamlet model: a case study. J Gen Intern Med 25(12): 1375-1378. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988157/?tool=pubmed

Sacks, F. (2011). Telephone coaching as effective for weight loss as in-person counseling. Endocrine Today. 11/15/11. Available from http://www.endocrinetoday.com/view.aspx?rid=89604.

Sperl-Hillen, J., S. Beaton, et al. (2011). Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes: A Randomized Controlled Trial. Arch Intern Med. 10/10/11. Published online doi:10.1001/archinternmed.2011.507

TeleVox (2011) A Fragile Nation in Poor Health: Realities About Why So Many Americans Fail to Follow Their Doctor’s Orders Strategies For Improving Patient Cooperation. Available from http://www.jonespr.net/images/TeleVox-PoorHealthStudyFNL.pdf

Terry, P. E., Seaverson, E. L., et al. (2010). A comparison of the effectiveness of a telephone coaching program and a mail-based program. Health Educ Behav 37(6): 895-912.

Wolever, R. Q.; Dreusicke, M. et al. (2010). “Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial.” Diabetes Educ 36(4): 629-639.