- Health coaching conducted by medical assistants is an effective measure for preventing or managing chronic illness, alleviating some management burden from clinicians, according to a study published in the Journal of the American Board of Family Medicine.
Health coaching is an effective patient engagement strategy because it puts disease and health management directly into the patient’s hands, the researchers suggested. Health coaches do not drive the management, but rather guide the patient through it.
“Health coaching focuses on internal motivation and encouraging goal setting that is defined by the individual,” the researchers explained. “The premise of this study was that information is readily available and community resources are in place to support healthy lifestyle strategies. The coach was simply the catalyst to elicit goal setting and to formulate a plan for implementation of steps to reach goals.”
Meaningful health coaching has fallen by the wayside as clinician workloads increase. Despite widespread calls for better disease management and patient coaching, clinicians cannot take on this added work.
However, medical assistants may be effective in delivering patient health coaching services. Medical assistants are individuals who have received at least an associate’s degree in medical practice. In this study, two medical assistants underwent a short training period before interacting with patients as health coaches.
Following the training, the medical assistants worked with a group of 82 patients during a 12-week program. By program’s end, 72 percent of patients had completed 8 weeks of the program and 49 percent completed the full 12-week program.
The patients who completed most or all of the program saw significant health benefits, the researchers reported. Participants largely saw improvements in both diet and physical activity.
These improvements ultimately resulted in substantial weight loss, especially for those patients who completed the entire 12-week program. This finding was significant because weight loss was not a primary research measure.
“Health coaching was specifically designed to avoid a focus on weight loss because of the persistent problem of weight regain following loss,” the researchers explained. “Beneficial behavior changes also may not result in immediate weight loss, which could be discouraging. Thus, we chose to focus on behaviors that underlie health.”
The program was effective in driving those behaviors that define general health, the researchers concluded. Total physical activity increased by 136 minutes per week. And while improvements in diet were small, the researchers explained that baseline diet measures were already relatively healthy.
The program was largely successful because patients set their own wellness goals, the researchers noted. While the health coaches guided patients through the course and consulted with patients regularly, personal goal-setting was the main driver for program success.
“The coaching method focused on eliciting goal setting and creating implementation intentions using a form developed for this study,” the researchers said. “In this way, subjects identified for themselves how to accomplish their own goals.”
Despite the program’s effectiveness, the researchers said there was less-than-optimal uptake and retention.
“This might have been improved if methods to refer to health coaching were streamlined and more integrated into clinic visits,” the research team theorized. “Providers did indicate that remembering to refer patients was a barrier.”
Patients, providers, and health coaches reported satisfaction with the program despite referral barriers.
The researchers also suggested a shorter program duration to improve patient retention. While just about half of patients completed the full 12-week program, nearly three-quarters finished 8 weeks. Condensing the program to 8 weeks may be effective for ensuring patients complete the key points and conclusion of the program.
“This study did have better subject retention over 8 versus 12 weeks, indicating that a brief coaching intervention might be more realistic within an office setting,” the research team recommended. “For effecting larger lifestyle changes, more intensive programs are more effective”
Ultimately, offering health coaching from medical assistants can be a cost-cutting patient engagement strategy. Having medical assistants deliver the health coaching is more cost effective than those same services coming from a physician or nurse practitioner, the researchers said.
Additionally, effective wellness and chronic care management can potentially reduce healthcare costs down the road.
“Health coaching could prove to be a cost-effective method for improving the health of patient populations, and it could reduce physician time spent counseling patients,” the researchers concluded. “The results indicate that both providers and patients were highly satisfied with having health coaching available in the practice.”