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Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial
- Source :
- Annals of family medicine, vol 13, iss 2, Willard-Grace, R; Chen, EH; Hessler, D; Devore, D; Prado, C; Bodenheimer, T; et al.(2015). Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: A randomized controlled trial. Annals of Family Medicine, 13(2), 130-138. doi: 10.1370/afm.1768. UCSF: Retrieved from: http://www.escholarship.org/uc/item/92k961b7
- Publication Year :
- 2015
- Publisher :
- eScholarship, University of California, 2015.
-
Abstract
- © 2015, Annals of Family Medicine, Inc. All right reserved. PURPOSE Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care. METHODS We conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California. The primary outcome was a composite measure of being at or below goal at 12 months for at least 1 of 3 uncontrolled conditions at baseline as defined by hemoglobin A1c, systolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Secondary outcomes were meeting all 3 goals and meeting individual goals. Data were analyzed using χ2 tests and linear regression models. RESULTS Participants in the coaching arm were more likely to achieve both the primary composite measure of 1 of the clinical goals (46.4% vs 34.3%, P =.02) and the secondary composite measure of reaching all clinical goals (34.0% vs 24.7%, P =.05). Almost twice as many coached patients achieved the hemoglobin A1c goal (48.6% vs 27.6%, P =.01). At the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (41.8% vs 25.4%, P =.04). The proportion of patients meeting the systolic blood pressure goal did not differ significantly. CONCLUSIONS Medical assistants serving as in-clinic health coaches improved control of hemoglobin A1c and LDL levels, but not blood pressure, compared with usual care. Our results highlight the need to understand the relationship between patients’ clinical conditions, interventions, and the contextual features of implementation.
- Subjects :
- Counseling
Male
Comparative Effectiveness Research
Glycated Hemoglobin A
Allied Health Personnel
Blood Pressure
Cardiovascular
Medical and Health Sciences
law.invention
Randomized controlled trial
law
Health care
Original Research
practice-based research
education.field_of_study
Self-management
Diabetes
Middle Aged
medical assistants
Treatment Outcome
Cholesterol
Studies in Human Society
Hypertension
Health education
Female
Family Practice
Type 2
vulnerable populations
Adult
medicine.medical_specialty
Health coaching
education
Population
Clinical Trials and Supportive Activities
Hyperlipidemias
LDL
primary care
motivation
Clinical Research
Diabetes mellitus
General & Internal Medicine
medicine
Diabetes Mellitus
chronic disease management
health education
Humans
Poverty
Glycated Hemoglobin
Primary Health Care
business.industry
Prevention
Cholesterol, LDL
medicine.disease
Self Care
Blood pressure
Good Health and Well Being
Diabetes Mellitus, Type 2
Family medicine
Physical therapy
Linear Models
business
human activities
Safety-net Providers
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Annals of family medicine, vol 13, iss 2, Willard-Grace, R; Chen, EH; Hessler, D; Devore, D; Prado, C; Bodenheimer, T; et al.(2015). Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: A randomized controlled trial. Annals of Family Medicine, 13(2), 130-138. doi: 10.1370/afm.1768. UCSF: Retrieved from: http://www.escholarship.org/uc/item/92k961b7
- Accession number :
- edsair.doi.dedup.....754d8a01019bae3d4db07aba472640e8