Episode 56 | Oct 26, 2023

What Research Says About Health Coaches

Join Dr. Sandi on a riveting journey through the cutting-edge world of functional medicine health coaching. In this episode, she unveils three groundbreaking research papers that shed light on the profound impact of health coaching in the realm of chronic illness management. Dr. Sandi always says, “Health coaching is the new primary care,” and these new studies showcase the truth in that statement. According to one study, health coaching improved workforce outcomes. Another showed the benefits of collaborative care teams for both patients and physicians. Health coaching is improving healthcare and the research confirms it.

In This Episode:

• Learn how health coaching resulted in positive outcomes for aging adults.
• See what doctors are saying about working in collaborative care teams
• Does health coaching improve labor outcomes?
• How is health coaching improving outcomes for patients with type 2 diabetes?

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Episode Transcript

Dr. Sandi: Welcome back to another episode of Health Coach Talk. I am your host, Dr. Sandra Scheinbaum. And today it is just me. We are doing this solo episode so that I can share some of the latest research. I love finding studies about the effectiveness of coaching and sharing them, and then you can take those studies, if you happen to be a health coach, and sharing them with those who might be interested in learning that health coaching is very, very effective, or if you are perhaps thinking about becoming a coach, perhaps you will be inspired by learning all the ways that health coaches are making a huge impact.

So, let’s dig in. So, I’ve prepared some slides to accompany this talk. And if you are viewing this on YouTube, then you will be able to access these slides. And if you are listening, I invite you to head over to our YouTube channel so that you can see these slides as well.

Let’s begin. The first study has to do with health coaching for older adults. So, this is some super important research, and I think it could be a gamechanger for people over 50 with chronic conditions, so I’m very passionate about this subject about older adults because I am in that category being in my 70s.

So, let’s set the stage. The study that we are discussing today is about a program that they called the healthy lifetime. This was published in the BMC Primary Care, and it is a randomized trial of a theory-driven model of health coaching for older adults, both short-term and sustained outcomes. It was a personalized approach. The goal was to see if they could delay functional decline and minimize the complications of chronic conditions. And the cool thing was that it is delivered electronically. It included face to face video conferencing.

So, the researchers wanted to know, did this actually work? And they had two groups. It was the healthy living, the healthy lifetime group, let’s call it HL, and then the usual care group. And they didn’t state specifically what that usual care was but perhaps they just give some education. There were 59 people in the intervention group, the healthy living group, and 63 in the usual care group.

In over eight weeks, the group that was in the healthy living component, they received health coaching. The health coaching was done by trained nurses who are making wonderful coaches. In fact, you don’t even need healthcare training. We know this, you can be a good coach coming from a completely different background. But in this particular study, they did use nurses who had training in coaching, and they measured outcomes at the start, at the 8-week point, and then again at 20 weeks after the study began.

Okay, drum roll please. The results were promising. So, those people who are in the healthy living group improved their health habits at 8 weeks and they sustained it at 20 weeks, and that is really the significant marker. So, there were those who had high blood pressure. They saw improvements, but in that group for the high blood pressure was not sustained. They made gains initially but not at 20 weeks.

The usual care group, they had no significant improvements. I’m going to say that again, no significant improvements in the usual care group. Well, why are we not surprised? So, what does this all mean? Well, if you were one of those people in the healthy living group, you were seeing positive changes in your health habits, and you were sustaining those improvements over time, 20 weeks. So, considered that changing health habits alone can reduce all-cause morbidity, mortality, and chronic disease, this is really significant. It’s big news.

So, what are they concluding? High-functioning, community-dwelling, that means they’re not in nursing homes, older adults with chronic diseases are an important target for primary care, but primary care practitioners, the doctors, the nurse practitioners, they are overwhelmed with acute care. They have very, very big caseloads. They’re only seeing people for seven, eight minutes per visit. So, they don’t have time or capacity to do this healthy lifestyle coaching. So, who’s going to do it? Coaches. We need more coaches who can work with this population. It’s very significant.

So, let’s move on to the next study. This one I loved. Lifestyle changes give you an edge in the labor market. That is my interpretation of the study. That is the headline that should be making news. So, this study will be very important because we often focus on the health benefits of lifestyle change. But in this study, they’re looking at something else. How do making these changes spill over into other aspects of your life, specifically being able to have a job, being employable, being able to do well at your job, particularly if you are an older adult?

So, here’s the name of the study. It was the Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes, and it was published in JAMA. So, this is a significant piece of research. And let’s get into the details of the study. It was a cohort study. It was connected with a clinical trial data. They looked at Social Security administration records. There were a lot of people involved, 3,091 participants. They were between the ages of 45 and 75. They had type 2 diabetes and weight issues. They were divided into two groups. One was receiving this intensive lifestyle intervention, and the other just got diabetes education, usual care.

So, you might be wondering about this intensive lifestyle intervention. Well, it was a structured program, and it had a lot of people involved on the care team. It had sessions with lifestyle counselors, think health coaches, dietitians, exercise specialists, and behavior therapists. And let me tell you that coaches do really well. They’re really effective helping people with behavioral issues. So, they met weekly for the first six months, and then they scaled it down to monthly sessions by the fourth year. So, this was a long study. The goal was to achieve and maintain at least a 7% weight loss, and it was specifically focused on weight loss.

On the flip side, the control group, they had a much lighter touch. They received group-based diabetes education sessions three times a year for the first four years and then just one annual session after that. So, just think about that, how much impact is that really going to make? It’s not about just spoon-feeding people education. They’ve heard it all. They may go online and get all that information, but it’s about committing to making those changes when you have a health coach working with you, holding you accountable, acting as your ally. That’s how changes actually can happen.

So, here’s the big finding, and that is the intensive lifestyle intervention had a higher level of employment compared with the control group. They had a 2.9% increase in employment. What does that mean? It means they were better able to go out and get work. So, this is significant. So, the takeaway then is that better chronic disease management improves labor market outcomes. So, pretty clear. And when you are managing a chronic condition like diabetes through an intensive lifestyle intervention, which is also going to lead to some weight loss, it’s going to have a positive impact on your employment situation. You might be more likely to go out and seek a job. You might be more likely to get hired and perform well on that job. So, again, it’s not just about physical health, but it’s also how you engage with your work and remain productive in the labor market. And that’s what people want. They want to be vibrant. They want to be making a difference in terms of feeling better, having more energy, and that will lead to consequences such as being more employable.

So, this was a study I was really excited about. It’s about improving blood glucose levels in populations that are often not studied, marginalized, African-American, Hispanics. So, this is the title, Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Controlled Trial. And, again, drum roll please, it’s in JAMA Network. This is a very significant study. I loved it because when I read the details, this is in my community, my hometown. This is the University of Illinois at Chicago. I was very familiar with that campus, that university, and it’s nice to see that this study was taking place in an academic setting, and it was really cool.

Let me share some of the details. It’s an incredible topic how mobile health tools combined with health coaching can make a big difference in managing type 2 diabetes for these populations. So, it comes again from an academic medical center. It involves 221 African-American Hispanic participants. All of them had type 2 diabetes with elevated hemoglobin A1C levels. As you may know, those are the markers over time, over three months showing what happens with blood sugar glucose that is binding to protein. And so it is a good marker. You want to see the numbers coming down. It’s a marker for long-term blood glucose control.

So, the participants were divided into two groups. The first group… And do we see a pattern here? These are randomized controlled trials in these studies. So, this is the gold standard. So, the first group in this study was part of the intervention. They received one year of this mobile health program, and it included the works. It had clinical pharmacists and health coaches of the pharmacist plus the health coach. That is a great team. They were connecting with these patients through video telehealth platforms as well as text messaging. Again, same pattern here. The second group got their usual diabetes care, and then after the year was up, they got the mHealth or the mobile health treatment. So, again, the control group just gets business as usual. We’re looking at the effects of this intervention group.

It’s such a good finding. The primary outcome here was that high hemoglobin A1C levels…guess what. The intervention group showed a very significant drop on average. Their hemoglobin A1C improved by 0.79 percentage points compared to just 0.24 percentage points for the business as usual control group.

But the magic doesn’t stop there. The control group, which later received the same interventions after the study was over, they didn’t want the people in the control group to miss out on the opportunity to improve their health. So, they got the intervention with the pharmacists and the health coaches, and they showed significant decreases in their hemoglobin A1c levels. So, what does this all mean? Oh, that’s pretty clear. This mobile health intervention with health coaches is doing something right, and we need to pay attention because, as you know, type 2 diabetes is a huge problem, particularly in these underserved minority populations that we are talking about here. So, anything that we can do to reduce the incidence, to intervene with lifestyle intervention is going to be effective.

So, what does this mean overall? These types of interventions with a health coach significantly improves hemoglobin A1c. And it has a huge potential to reduce the racial and ethnic disparities in health care. Just note what they were doing. This was very hands on. These people were getting really wonderful coaching, state of the art care. It wasn’t just the business as usual where they get some education about blood glucose levels. So, this study adds another layer to the growing evidence that health coaching combined with technology, and they were using text messaging but they were also using telehealth visits. This can help people make meaningful changes in their life. So, very, very significant.

Now, is this catching on? I want to turn to something else. And this is a model that I saw written up, and I got really excited. It is a team-based care model, an external team. And I’m saying to you that primary care could be transformed if we follow a model like this. So, let me tell you the story of this remarkable healthcare system. So, the title is Primary Care Transformation: A Team-Based Care Model. It was published in the American Journal of Accountable Care.

So, let me tell you about the Allegheny Health Network. This is in primarily Western Pennsylvania. It’s a big, big organization. They have a lot of primary care practices, hundreds of them, and they were wanting to transform this primary care delivery model to improve patient outcomes, practice efficiency, and clinician wellness. That’s a great goal. All of those are. The goals included better care coordination, enhanced chronic disease management, and integration of social determinants of health.

What did the health coaches do on the team? They were focused on population health efforts, lifestyle change, including a pre-visit paneling. So, they were actively engaged with patients pre-visit, which I strongly advocate for health coaches. Facilitation of care team huddles. I love that. I just can picture those health coaches really taking care of those other care team members. And then proactive population outreach. So, they’re heavily involved on this team. And the external care teams support continuity of care, appropriate utilization. It’s the right care in the right place at the right time, and they are holistically managing patients. They started small with a number of practices, and now they’re extending it. These are primary care, and they’re planning to extend it to pediatric and women’s health, OBGYN practices as well.

This is what I thought was so cool. The feedback from participating physicians highlights the perceived value of team-based care. This is a model that you can share. If you are speaking to practitioners, if you are a practitioner or someone who is running a large practice system, this is worth noting. These doctors, they said they cannot imagine returning to how they practiced medicine before the addition of the extended care teams. Let me say that again. These are the physicians saying this, they cannot imagine returning to how they practice medicine before the addition of the external care teams. Wow. And we know that physicians and other providers are so burned out, and they’re often attempting to do everything themselves. The extended care team is the way to go, and the study shows that.

I love this quote. This was from one of the researchers. The process of transformation has helped us to focus on delivering upon the quintuple aim of healthcare. Number one, reducing cost. Number two, improving quality. Number three, optimizing patient experience. Number four, supporting clinicians’ wellness. Number five, ensuring health equity.

Well, the Allegheny Health Network is a role model for primary care practices, one that should be adopted by many others having an extended care team, and having a health coach as part of that team is crucial. And what I always say is the health coach is the new primary care. Health coaching, the new primary care because health coaching is the solution to many of the issues that are plaguing our current healthcare system. They’re not taking the place of medical doctors. They are offering lifestyle change, and that is what needs to be first. It needs to be primary if we are ever going to get a hold of this epidemic of chronic disease. So, we’ve seen many examples through these studies that I have just referenced. So, I hope that you found that helpful.

So, that is it for today’s solo episode. Let’s keep taking control of our health one step at a time. And if you found this episode useful, we would be so grateful if you liked it, if you shared it, if you subscribed. So, until next time. Bye, everybody.

Dr. Sandi: Thanks for listening and stay tuned for more episodes of Health Coach Talk. Are you ready to continue your own health coaching career journey? Visit functionalmedicinecoaching.org to learn more about our health coach certification program. Functional Medicine Coaching Academy Inc. is providing this podcast as a public service, but it is neither medical advice or a statement of policy. Reference to any specific product or entity does not constitute an endorsement or recommendation. Views and opinions expressed by our guests are their own. Discussions are not medical advice. Be sure to consult your practitioner for your healthcare needs.