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Health coaches helped low-income patients with type 2 diabetes reach goals
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SAN FRANCISCO — Health coaching improved clinical outcomes for low-income patients with type 2 diabetes compared with normal care, according to research presented at the American Diabetes Association’s 74th Scientific Sessions.
“There are a lot of potential barriers that go on in patients’ lives, and a lot of potential mechanisms by which health coaching may be helping these patients,” Rachel Willard-Grace, MPH, of the University of California, San Francisco, said during her presentation.
Willard-Grace and colleagues looked at 378 patients diagnosed with uncontrolled type 2 diabetes, hypertension and/or hyperlipidemia over a period of 1 year to gauge the impact of medical assistants, with 40 hours of health coach training, in reaching their goals.
The researchers randomized patients from two urban safety net clinics to coaching (n=224, 52% female, mean age=52±11, BMI=31.4±6.7) or usual care (n=217, 58% female, mean age=53±11, BMI=31.5±7). Patients primarily spoke Spanish; more than half did not complete high school and earned less than $10,000 per year.
Health coaches were asked to see patients face-to-face at least every 3 months and to make contact at least once each month. Study results were quantified based on primary outcome, reaching goal for at least one condition at the end of the study, and secondary outcome, meeting all goals and each goal separately.
Patients who received health coaching were more likely to reach primary outcome than usual care (46.4% vs. 34.3%, difference 12.1%, CI 2%-23%) as well as secondary outcome (34.0% vs. 24.7%, difference 9.3%, CI 1%-19%).
Nearly twice the amount of patients achieved the HbA1c specific goal of ≤8% with health coaching than usual care (48.6% vs. 26.6%, difference 22.0%, P<.05). More patients with health coaching achieved the LDL cholesterol specific goal at the largest study site compared with usual care (41.8% vs. 25.4%, difference 16.4%, P<.05). No significant difference was seen in patients who reached the treatment goal for hypertension.
“There’s an element of health coaching and health care that’s really about relationships, and without that we don’t really know what’s going on with patients,” Willard-Grace said. “Health coaches can help to solidify these relationships.” — by Allegra Tiver
For More Information: Willard-Grace R. Abstract 317-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Disclosures: Willard-Grace reports no relevant disclosures.