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Article Title

Medical Assistants as Health Coaches: Helping Obese Patients Set Goals

Publication Date

4-30-2015

Keywords

health coaching, behavior change

Abstract

Background/Aims: Obesity is a common condition seen in primary care. However, there have been few programs for obese patients within existing primary care infrastructure. We sought to develop a program to train medical assistants to provide brief health coaching on weight management and help patients set goals.

Methods: Coaching was based on motivational interviewing and brief action planning. We used a mixed-methods, iterative approach to refine the intervention to prepare for broader dissemination. We summarize key events, themes and data collected.

Results: We convened a team of researchers, providers and operational leaders. In the first 2 months, we trained all 8 medical assistants (MAs) in one primary care clinic and worked with them to launch the intervention. A senior interventionist mentored and provided supervision to the MAs over several improvement cycles during a 4-month period. We conducted qualitative interviews to obtain feedback 6 months into the project. Barriers included patient reluctance to talk about weight management, preference for more provider involvement, and time constraints. Facilitators included feeling that the topic is important, support from the supervision and training team, and positive coaching experiences. We made changes to the intervention based on the interviews and meetings with the clinic providers. During a 1-month period 8 months after launch, there were 1,143 adult primary care encounters to an average of 5 primary care providers over 21 clinic days. One-third (36%, n=409) were by patients with a body mass index > 30, and of these, 5.4% of patients were coached by an MA. The MAs coached a total of 23 patients, or 5.5 patients per week.

Discussion: Brief health coaching by MAs coaching may be feasible once key barriers are addressed. We are currently piloting revised procedures and continuing to mentor MAs and providers through 2014.

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