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Article Title

Health Coaching for Patients With Diabetes and Hypertension: Filling a Gap for Patients and Physicians

Publication Date

4-30-2015

Keywords

health coach, chronic conditions

Abstract

Background/Aims: Health coaching is a novel primary care team-based care model using clinically supervised unlicensed providers to help patients make lifestyle changes and improve self-management of diabetes and/or hypertension. Previous health coaching programs have largely targeted indigent patients. It is unknown how privately insured patients and fee-for-service providers in community practices would respond to and use health coaching services.

Methods: Findings are drawn from a study conducted at a large multispecialty clinic serving approximately 29,000 patients with diabetes or hypertension. Data were gathered 6 months after implementation of the health coach program and include observation/audio recordings of 8 health coach appointments, interviews with 8 patients, 7 referring physicians, 2 health coaches and 1 nurse practitioner clinical supervisor, and electronic health record (EHR) visit data.

Results: Out of the 2,342 patients with a diabetes- or hypertension-related primary care visit during this period, 197 (12%) had health coach referrals in the EHR, and 113 (5%) had at least one health coach visit. Patients averaged 2.5 (standard deviation: 2.6) health coach visits, but the range included 1 to 19 visits during this time period. Health coaching involved direct time spent coaching patients and indirect time spent on care management and navigation. Direct coaching ranged from biweekly in-person visits to monthly phone calls. An average in-person visit was 38 minutes (min: 18, max: 74, standard deviation: 18.9 minutes). Health coaches developed a distinct relationship with patients; they worked together to develop plans that addressed not only health concerns such as diet, exercise and monitoring of blood pressure/sugar, but also personal concerns regarding finances, family, etc. Physicians differed in the language they used to describe the health coach program to patients and in their criteria for health coaching referrals. Physicians were appreciative of health coaches as members of an extended care team and as liaisons between patients and services or resources.

Discussion: The role of health coaching in this primary care setting is still evolving and adjusting to meet varying levels of patient needs and preferences for contact. Health coaching fills a gap for patients and physicians who both benefit from an extended but flexible relationship that provides a new type of support.

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