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Improve Patient Compliance & Outcomes With Health Coaching

A mutually empowering patient-practitioner relationship is a key element of the Functional Medicine model. Recent studies suggest that establishing and maintaining a strong, empathic relationship with the patient may be the most crucial factor for his or her success in the long-term with lifestyle changes such as weight loss, tobacco cessation, and increased activity level.1,2

Clinicians know how important this lifestyle change can be. Unhealthy lifestyle behaviors are considered modifiable risk factors for many diseases, including cardiovascular disease,3 type 2 diabetes,4 cognitive decline,5 and many more. Lifestyle interventions target certain behaviors that deteriorate patient health, namely poor diet and inadequate physical activity, which impact chronic illness outcomes.

Improving the Patient-Provider Relationship

Health coaching can help patients make sustainable lifestyle changes that stick. One of the reasons for this seems to be the patient’s perceived improvement in the patient-provider relationship that health coaching may provide. Cultivating the patient-provider relationship matters because it tends to reduce costs, increase patient loyalty, and improve long-term patient compliance and outcomes.6 Patient trust in their practitioner and commitment to the health plan are likely to improve their outcomes as well.7

When all parties buy in, the signs suggest health coaching is effective and satisfying. For instance, in a randomized controlled trial, 750 patients with complex, chronic disease received either health coaching intervention or usual care.8 Patients who received health coaching had lower re-hospitalization rates and lower average hospital costs.

In the following video, IFM educator Patrick Hanaway, MD, talks about the critical role that a collaborative care team that includes nutritionists and health coaches plays in helping patients make the behavior/lifestyle changes they need for optimal health:

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Steps to Sustainable Lifestyle Change

Another benefit of health coaching is that coaches provide step-by-step instructions on how to implement change, along with continued feedback on how the change is going. A major role of health coaches is to listen to and guide patients through a change process: setting expectations, providing feedback, and helping patients identify challenges along the way.9 One study of diabetes patients identified multiple themes that make health coaching successful, including physician buy-in, a mutual understanding of the health coach role by both patient and provider, and the patient’s readiness to receive health coaching.10 Studies show that health coaching interventions target behavior changes aligned with self-determined goals, leading to improved physical and mental health outcomes.11

A 2015 study of patients with type 2 diabetes who underwent a health coaching intervention demonstrated a reduction in HbA1c, significant decreases in weight and waist circumference, and improvements in mood, satisfaction with life, and quality of life.11 A 2009 study of overweight, insulin-resistant individuals found that while weight loss and improved cardiovascular risk factors improved during a four-month intervention, more frequent monitoring for an indefinite period of time was necessary for nearly two-thirds of patients to maintain their lifestyle changes long-term.12

Recent studies suggest that health coaching is not only useful for common lifestyle-linked issues like obesity and diabetes, but has been shown to be effective for many chronic issues, including anxiety,13 low back pain,14 and even oral hygiene.15

In practice, studies have shown that health coaching can be effectively implemented by clinicians, medical assistants, or support staff, especially in small care clinics and group visits.10,16,17 Health coaching may even reduce physician burnout by providing “a results-oriented and stigma-free method . . . primarily by increasing one’s internal locus of control,” one study suggested.18

Conclusion

Functional Medicine is based on the principle that patients do best when there is a therapeutic partnership between the practitioner and patient. As the studies on health coaching suggest, there is a critical relationship between the level of control that patients feel they have over their own health and their success in making and sustaining lifestyle changes that impact their overall wellness. IFM provides clinicians with specific tools, like the IFM Timeline, Matrix, and GOTOIT framework, that help them understand the patient’s perceptions of their health and allow for the co-creation of an individualized therapeutic plan that integrates sustainable lifestyle change with other interventions that target the underlying cause of each patient’s disease.

Learn more about enhancing your patient relationships and implementing new tools that help your patients make sustainable lifestyle changes by attending IFM’s Applying Functional Medicine in Clinical Practice (AFMCP).

Learn More About Functional Medicine

Learn more about Functional Medicine health coaching from the Functional Medicine Coaching Academy.

References

  1. Brandt CJ, Søgaard GI, Clemensen J, Søndergaard J, Nielsen JB. Determinants of successful eHealth coaching for consumer lifestyle changes: qualitative interview study among health care professionals. J Med Internet Res. 2018;20(7):e237. doi:10.2196/jmir.9791
  2. Brandt CJ, Clemensen J, Nielsen JB, Søndergaard J. Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study. BMJ Open. 2018;8(3):e017466. doi:10.1136/bmjopen-2017-017466
  3. Shrestha R, Copenhaver M. Long-term effects of childhood risk factors on cardiovascular health during adulthood. Clin Med Rev Vasc Health. 2015;7:1-5. doi:10.4137/CMRVH.S29964
  4. Van Buren DJ, Tibbs TL. Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children. Curr Diab Rep. 2014;14(12):557. doi:10.1007/s11892-014-0557-2
  5. Phillips C. Lifestyle modulators of neuroplasticity: how physical activity, mental engagement, and diet promote cognitive health during aging. Neural Plast. 2017;2017:3589271. doi:10.1155/2017/3589271
  6. Dorr Goold S, Lipkin M Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14(Suppl 1):S26-S33. doi:10.1046/j.1525-1497.1999.00267.x
  7. Berry LL, Parish JT, Janakiraman R, et al. Patients’ commitment to their primary physician and why it matters. Ann Fam Med. 2008:6(1):6-13. doi:10.1370/afm.757
  8. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828. doi:10.1001/archinte.166.17.1822
  9. Hayes E, Kalmakis KA. From the sidelines: coaching as a nurse practitioner strategy for improving health outcomes. J Am Acad Nurse Pract. 2007;19(11):555-562. doi:10.1111/j.1745-7599.2007.00264.x
  10. Liddy C, Johnston S, Nash K, Ward N, Irving H. Health coaching in primary care: a feasibility model for diabetes care. BMC Fam Pract. 2014;15:60. doi:10.1186/1471-2296-15-60
  11. Wayne N, Perez DF, Kaplan DM, Ritvo P. Health coaching reduces HbA1c in type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial. J Med Internet Res. 2015;17(10):e224. doi:10.2196/jmir.4871
  12. Dale KS, Mann JI, McAuley KA, Williams SM, Farmer VL. Sustainability of lifestyle changes following an intensive lifestyle intervention in insulin resistant adults: follow-up at 2-years. Asia Pac J Clin Nutr. 2009;18(1):114-120.
  13. Mohr DC, Schueller SM, Tomasino KN, et al. Comparison of the effects of coaching and receipt of app recommendations on depression, anxiety, and engagement in the IntelliCare Platform: factorial randomized controlled trial. J Med Internet Res. 2019;21(8):e13609. doi:10.2196/13609
  14. Shebib R, Bailey JF, Smittenaar P, Perez DA, Mecklenburg G, Hunter S. Randomized controlled trial of a 12-week digital care program in improving low back pain. NPJ Digit Med. 2019;2:1. doi:10.1038/s41746-018-0076-7
  15. Scheerman JFM, van Meijel B, van Empelen P, et al. The effect of using a mobile application (“WhiteTeeth”) on improving oral hygiene: a randomized controlled trial. Int J Dent Hyg. Published online July 10, 2019. doi:10.1111/idh.12415
  16. Willard-Grace R, DeVore D, Chen EH, Hessler D, Bodenheimer T, Thom DH. The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population. BMC Fam Pract. 2013;14:27. doi:10.1186/1471-2296-14-27
  17. Sang MJ, Benavente V. Health coaching in nurse practitioner-led group visits for chronic care. J Nurse Pract. 2016;12(4):258-264. doi:10.1016/j.nurpra.2015.11.015
  18. Gazelle G, Liebschutz JM, Riess H. Physican burnout: coaching a way out. J Gen Intern Med. 2015;30(4):508-513. doi:10.1007/s11606-014-3144-y

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