Delivery of Health Coaching by Medical Assistants in Primary Care

Abstract

Background Health coaching is potentially a practical method to assist patients in achieving and maintaining healthy lifestyles. In health coaching, the coach partners with the patient, helping patients discover their own strengths, challenges, and solutions. Methods Two medical assistants were provided with brief training. The 12-week program consisted of telephone coaching with in-person visits at the beginning and end of the program. Coaching targeted improvements in diet, physical activity, and/or sleep habits using a self-care planning form. Results A total of 82 subjects enrolled in the program, 72% completed 8 weeks and 49% completed 12 weeks. Subjects who completed assessments at 12 weeks had significant weight loss despite the fact that weight loss was not a study goal. There also were improvements in diet and physical activity. Subject who completed the study were highly satisfied with the program and felt that health coaching should be available in all family medicine clinics. The main barrier providers voiced was remembering to refer patients. The medical providers indicated high satisfaction with the study and valued having coaching available for their patients. Conclusions Medical assistants can be trained to assist patients with lifestyle changes that are associated with improved health and weight control.

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

“…Some pilot programs have found improvements in cancer screenings 4,6 , cholesterol levels 21 , diabetes control 11,21 , medication adherence 19 , physical activity levels and body mass index. 9 However, Ferrer and colleagues 2 found that there was poor adoption of MA health coaching, and several randomized trials testing the effects of MA diabetes health coaches found no significant differences in hemoglobin A1C levels or hospitalizations between control and intervention group patients. 10,13,15,18 There is currently a limited understanding as to why there was success in some studies and not others.…”

“…5 They also serve as health coaches to improve lifestyle behaviors 9 , chronic disease care processes 3,10 -18 , and medication adherence. 19 These innovative MA roles have been reported across diverse settings, including private practices 2,3,5,20 , community health centers 5,10,13,15,16,19 , academic primary-care practices 8,9,12,14 , rural practices 17 , and large health care systems. 4,5,7 Outcomes in studies that have focused on or included MA role expansion or innovation have varied.…”

Coaching nutricional y motivación para el cambio de conducta alimentaria

“…Ha mostrado además resultados positivos en varios estudios, incluida la pérdida de peso, el control de la diabetes, la disminución de la presión arterial y mejoría en los comportamientos en salud 12 . También se ha visto la disminución en el tiempo invertido bajo la supervisión de un profesional de la salud, el incremento en la satisfacción de los usuarios por la entrega de un tratamiento personalizado, y un aumento en la confianza en el equipo de salud, cuando fue aplicada la metodología del coaching 12,13 .…”

“…Dado que el foco del trabajo con el paciente no es el problema de salud en sí, sino que su comportamiento, puede que la baja de peso si es lo esperado no ocurra de manera inmediata, lo que podría ser desalentador. Sin embargo, al focalizarse en las actitudes del paciente, es esperable que en las sesiones sucesivas, distintos aspectos de su vida vayan mejorando, siendo uno de ellos el manejo de sus conductas en salud, lo que se manifestará finalmente en los parámetros esperados 12,20,21 .…”

Research on Clinical Decisions Made Daily in Family Medicine

“…In this pilot study, Djuric et al 11 report positive weight-loss outcomes in the 49% of patients who completed 12 weeks of coaching. Overall, small differences were found at the end of the study.…”