Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial.

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 χ(2) 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.

Aplicação de healthbots em língua portuguesa: revisão narrativa / Application of healthbots in Portuguese: narrative review / Aplicación de healthbots en portugués: revisión narrativa

Objetivo: Esse estudo objetivou levantar e caracterizar as aplicações de healthbots em língua portuguesa, considerando seus papéis na transformação digital da jornada do paciente. Métodos: Revisão de literatura narrativa pela qual se investigou a acessibilidade e a objetividade das aplicações, tendo o paciente como usuário final. Os artigos foram analisados quanto ao uso de bots, tecnologias da informação e dispositivos utilizados, objetivo das aplicações, área médica de intervenção e disciplinaridade no desenvolvimento das soluções. Resultados: De treze artigos selecionados na busca contendo aplicações com automatização de tarefas, apenas cinco descreveram a utilização de bots. Conclusão: Os healthbots possuem potencial para promover o aprimoramento da jornada do paciente. Contudo, o desenvolvimento e o emprego de tais aplicações ainda não estão difundidos no Brasil.

Objective: This study aimed to raise and characterize the applications of healthbots in Portuguese, considering their roles in the digital transformation of the patient's journey. Methods: Review of narrative literature through which the accessibility and objectivity of the applications were investigated, with the patient as the end user. The articles were analyzed regarding the use of bots, information technologies and devices used, purpose of applications, medical area of intervention and disciplinary action in the development of solutions. Results: Of thirteen articles selected in the search containing applications with task automation, only five described the use of bots. Conclusion: Healthbots have the potential to improve the patient journey. However, the development and use of such applications are still not widespread in Brazil.

Objetivo: Este estudio tuvo como objetivo plantear y caracterizar las aplicaciones de los healthbots en portugués, considerando sus roles en la transformación digital del viaje del paciente. Métodos: Revisión de literatura narrativa mediante la cual se investigó la accesibilidad y objetividad de las aplicaciones, con el paciente como usuario final. Los artículos fueron analizados en cuanto al uso de bots, tecnologías y dispositivos de información utilizados, finalidad de las aplicaciones, área médica de intervención y acción disciplinaria en el desarrollo de soluciones. Resultados: De trece artículos seleccionados en la búsqueda que contienen aplicaciones con automatización de tareas, solo cinco describieron el uso de bots. Conclusión: los Healthbots tienen el potencial de mejorar el viaje del paciente. Sin embargo, el desarrollo y uso de tales aplicaciones aún no está muy extendido en Brasil.

The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial.

BACKGROUND: Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence. METHODS: This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care. RESULTS: Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P < .001). CONCLUSIONS: Health coaching by medical assistants significantly increases medication concordance and adherence.

Clinician perspectives on working with health coaches: A mixed methods approach.

We sought to understand how health coaches affect the work of primary care clinicians and influence their perception of patient care. As a mixed methods hypothesis-generating study, we administered a structured post-visit survey and conducted in-depth individual interviews with primary care clinicians who worked with health coaches at two urban community health centers. Survey responses were compared using t tests. Interviews were transcribed and analyzed using Atlas.ti software and modified grounded theory. Surveys were completed by 15 of 17 clinicians for 61% of eligible patient visits (269/441). Compared to usual care patients, clinicians rated visits with health-coached patients as less demanding (2.44 vs. 3.06, p < .001) and were more likely to feel that they had adequate time with their patient (3.96 vs. 3.57, p < .001). Qualitative findings expanded upon these results and uncovered four key health coach activities thought to improve patient care. Through developing a rapport with patients over time and working with patients between medical visits, health coaches (a) empower patients by offering self-management support, (b) bridge communication gaps between clinicians and patients, (c) assist patients in navigating the health care system, and (d) act as a point of contact for patients.

Health coaching by medical assistants improves patients' chronic care experience.

OBJECTIVES: We sought to test the hypothesis that training medical assistants to provide health coaching would improve patients' experience of care received and overall satisfaction with their clinic. STUDY DESIGN: Randomized controlled trial. METHODS: Low-income English- or Spanish-speaking patients aged 18 to 75 years with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were randomized to receive either a health coach or usual care for 12 months. Patient care experience was measured using the Patient Assessment of Chronic Illness Care (PACIC) scale at baseline and at 12 months. Patient overall satisfaction with the clinic was assessed with a single item asking if they would recommend the clinic to a friend or family member. PACIC and satisfaction scores were compared between study arms using generalized estimating equations to account for clustering at the clinician level. RESULTS: PACIC scores were available from baseline and at 12 months on 366 (76%) of the 441 patients randomized. At baseline, patients receiving health coaching were similar to those in the usual care group with respect to demographic and other characteristics, including mean PACIC scores (3.00 vs 3.06) and the percent who would "definitely recommend" their clinic (73% and 73%, respectively). At 12 months, coached patients had a significantly higher mean PACIC score (3.82 vs 3.13; P < .001) and were more likely to report they would definitely recommend their clinic (85% vs 73%; P = .002). CONCLUSIONS: Using medical assistants trained in health coaching significantly improved the quality of care that low-income patients with poorly controlled chronic disease reported receiving from their healthcare team.