Medical Assistant Health Coaching for Low-Income Patients
Medical Assistant Health Coaching for Low-Income Patients
Chronic disease accounts for more than 80% of health care spending in the United States. Diabetes costs $132 billion each year in medical expenditures, lost workdays, and permanent disability and is projected to reach $192 billion in 2020. Cardiovascular disease costs $394 billion annually.
Medication adherence and lifestyle changes coupled with evidence-based practice guidelines are effective tools to control chronic disease. Yet half of patients with hypertension, 43% of people with diabetes, and 80% of people with hyperlipidemia have not reached their respective goals for blood pressure, glycemic control, or lipids. Half of patients do not take their chronic disease medications as prescribed, and only one in ten patients follow recommended guidelines for lifestyle changes, such as smoking cessation or healthy eating. Minority and low-income communities bear a disproportionate burden of chronic disease and its complications, and they are less likely to engage in effective self-management of their conditions.
Traditional didactic education shows little correlation with clinical outcomes such as glycemic control, blood pressure, and cholesterol. In contrast, self-management support, defined by the Institute of Medicine as the "systematic provision of education and supportive interventions to increase patients' skills and confidence in managing their health conditions," has been shown to improve clinical outcomes. Health Coaching, which is one form of self-management support, is designed to empower patients within the health care setting and in their daily lives. Within the health care setting, empowerment is characterized by voicing concerns, asking questions, providing information about home monitoring, and collaboratively developing care plans. In their daily lives, empowered patients are more likely to adhere to treatment plans and engage in lifestyle changes to effectively manage their chronic conditions.
There is growing evidence that primary care clinicians (physicians, nurse practitioners, and physician assistants) are not able to provide all needed preventive and chronic care support alone. It would require an estimated 21.7 hours per day for a clinician to meet the chronic, preventive, and acute care needs of a panel of 2,500 patients. New evidence-based models of care are needed to provide self-management support in primary care that is culturally and linguistically appropriate, as well as financially sustainable in resource-poor settings. Various members of the health care team have been proposed to deliver self-management support, such as nurse practitioners, registered nurses (RNs), medical assistants (MAs), volunteers, and other patients with the same condition. Of these, medical assistants represent a uniquely untapped resource for self-management support. As one of the fastest growing allied health professions, the medical assistant workforce is more ethnically and linguistically diverse than other medical professions and therefore more culturally and linguistically concordant with patient populations. Moreover, qualitative research on medical assistants has found that they often conceptualize their role as patient liaisons, cultural brokers, and "workers who care," roles that segue naturally into health coaching.
Previous studies of medical assistant health coaching programs found positive trends in clinical outcomes such as hemoglobin A1c but lacked power to find statistically significant differences or were not designed as randomized trials.
This is the first large, randomized controlled trial known to the authors to examine the effectiveness of training medical assistants to act as health coaches within primary care practices for patients with uncontrolled type 2 diabetes, hypertension, and hyperlipidemia. The results of this study will provide evidence about the clinical efficacy, barriers and facilitators to implementation, and cost of a health coaching model delivered by medical assistants within the primary care setting.
Background
Chronic disease accounts for more than 80% of health care spending in the United States. Diabetes costs $132 billion each year in medical expenditures, lost workdays, and permanent disability and is projected to reach $192 billion in 2020. Cardiovascular disease costs $394 billion annually.
Medication adherence and lifestyle changes coupled with evidence-based practice guidelines are effective tools to control chronic disease. Yet half of patients with hypertension, 43% of people with diabetes, and 80% of people with hyperlipidemia have not reached their respective goals for blood pressure, glycemic control, or lipids. Half of patients do not take their chronic disease medications as prescribed, and only one in ten patients follow recommended guidelines for lifestyle changes, such as smoking cessation or healthy eating. Minority and low-income communities bear a disproportionate burden of chronic disease and its complications, and they are less likely to engage in effective self-management of their conditions.
Traditional didactic education shows little correlation with clinical outcomes such as glycemic control, blood pressure, and cholesterol. In contrast, self-management support, defined by the Institute of Medicine as the "systematic provision of education and supportive interventions to increase patients' skills and confidence in managing their health conditions," has been shown to improve clinical outcomes. Health Coaching, which is one form of self-management support, is designed to empower patients within the health care setting and in their daily lives. Within the health care setting, empowerment is characterized by voicing concerns, asking questions, providing information about home monitoring, and collaboratively developing care plans. In their daily lives, empowered patients are more likely to adhere to treatment plans and engage in lifestyle changes to effectively manage their chronic conditions.
There is growing evidence that primary care clinicians (physicians, nurse practitioners, and physician assistants) are not able to provide all needed preventive and chronic care support alone. It would require an estimated 21.7 hours per day for a clinician to meet the chronic, preventive, and acute care needs of a panel of 2,500 patients. New evidence-based models of care are needed to provide self-management support in primary care that is culturally and linguistically appropriate, as well as financially sustainable in resource-poor settings. Various members of the health care team have been proposed to deliver self-management support, such as nurse practitioners, registered nurses (RNs), medical assistants (MAs), volunteers, and other patients with the same condition. Of these, medical assistants represent a uniquely untapped resource for self-management support. As one of the fastest growing allied health professions, the medical assistant workforce is more ethnically and linguistically diverse than other medical professions and therefore more culturally and linguistically concordant with patient populations. Moreover, qualitative research on medical assistants has found that they often conceptualize their role as patient liaisons, cultural brokers, and "workers who care," roles that segue naturally into health coaching.
Previous studies of medical assistant health coaching programs found positive trends in clinical outcomes such as hemoglobin A1c but lacked power to find statistically significant differences or were not designed as randomized trials.
This is the first large, randomized controlled trial known to the authors to examine the effectiveness of training medical assistants to act as health coaches within primary care practices for patients with uncontrolled type 2 diabetes, hypertension, and hyperlipidemia. The results of this study will provide evidence about the clinical efficacy, barriers and facilitators to implementation, and cost of a health coaching model delivered by medical assistants within the primary care setting.