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

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The authors argue that with primary care clinicians in increasingly short supply and overwhelmed by the expanding preventive and long term conditions in their patient populations, new evidence-based models of care are needed to provide self-management support through other members of the care team. 

Researchers in the USA assessed whether medical assistants (equivalent to ‘physician associates’ in the UK) could provide health coaching in primary care. (Read more about physician associates http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/car...). Throught their research the authors conclude that the medical assistant health-coaching model may provide an important answer to the barriers of time, resources, and cultural concordance faced by many primary care practices seeking to implement self-management support.

The researchers 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.

They found that patients who received health coaching were more likely to reach their goal for 1 or more of the conditions uncontrolled at baseline. They were also more likely to achieve control of all conditions. Almost twice the proportion of people in the health-coaching group achieved goals for glycemic control compared with the usual care group, and at the larger site, people receiving coaching were more likely to achieve the LDL cholesterol goal. 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. Health coaching did not improve control of hypertension in this study. Previous studies of health coaching to improve blood pressure control have yielded mixed results, with a number of multicondition studies failing to show improvement in blood pressure, while others have shown benefit.

The authors noted differences in results between the two sites piloting the approach. They found that there were indications that the quality of coaching differed at the latter site, including fewer interactions per patient and lower patient-reported trust in their health coach. The health coach at that site was absent for more than 8 weeks of the study and reported struggling to implement coaching principles. Unlike the coaches at the other site, this coach was not culturally concordant with the majority of patients. In addition, the sites differed in demographics of study participants and in the usual care delivery model.

They conclude that the study demonstrates that medical assistants can successfully serve as in-clinic health coaches to improve glycemic and cardiovascular health indicators over usual care. This model may satisfy several conditions needed for diffusion of innovation including relative advantage, compatibility, and scalability. As ubiquitous and relatively affordable members of the care team, medical assistants could provide critical self-management support even in resource-scarce settings.

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