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Health Coaching as a Strategy to Enhance Your Practice

African american psychiatrist talking to young male client
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A mutually empowering patient-practitioner relationship is a key element of the functional medicine model. Establishing and maintaining a strong, empathic relationship with a patient helps to sustain lifestyle-based interventions such as nutritional approaches, exercise and stress management programs, weight loss, and tobacco cessation.1,2

Clinicians know how important behavioral changes can be. Lifestyle-based interventions address modifiable risk factors for a number of chronic diseases and help to improve a patient’s health outcomes. Collaborative healthcare teams that include health coaches not only empower the therapeutic partnership but also enhance lifestyle treatment sustainability.3,4

Improving the Patient-Provider Relationship

Health coaching can help patients make 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 treatment adherence and outcomes.5 Patient trust in their practitioner and commitment to the health plan are likely to improve their outcomes as well.6

When all parties buy in, the signs suggest health coaching is effective and satisfying. For instance, a 2022 meta-analysis of 27 randomized controlled trials (RCTs) (N=9,100) suggested that patient coaching was one of the most effective intervention components at improving risk factor control (e.g., blood pressure, blood glucose, and lipids) in a diabetes population.7 Also, a 2019 meta-analysis of 10 RCTs involving patients with chronic obstructive pulmonary disease (COPD) reported that in addition to improving self-care behaviors, health coaching significantly reduced COPD-related hospital admissions and positively impacted health-related quality of life.4

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

(Video Time 2 minutes) Patrick Hanaway, MD, is a board certified family physician who teaches on the clinical application of nutritional biochemistry, with an emphasis on digestion, immunology, mitochondrial function, and wellness. Dr. Hanaway has served on the executive committee for the American Board of Integrative Medicine, is past president of the American Board of Integrative Holistic Medicine, and is the former director of research at Cleveland Clinic Center for Functional Medicine

Steps to Sustainable Lifestyle Change

Health coaching provides step-by-step instructions on how to implement change, along with continued feedback on how the change is going. The interventions target behavior changes aligned with self-determined goals, and a major role of health coaches is to listen to and guide patients through this change process: setting goals, providing feedback, and helping patients identify challenges along the way.8 One study of diabetes patients identified multiple themes that make health coaches on a collaborative care team 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.9

A 2021 community-based RCT (n=365) found that for adults with type 2 diabetes, a 12-month telephone diabetes health coaching intervention on glycemic control reduced A1C levels by an absolute amount of 1.8% while the usual diabetes education (control) reduced levels by 1.3%.10 In addition, another 2021 RCT (n=114 patients with type 2 diabetes) showed a significant decrease of 0.62% in HbA1C for those patients receiving a six-month health coaching intervention compared to the decrease of 0.14% in the control group.11 The health coaching intervention also improved diet quality, increasing daily vegetable intake.11

In addition to conditions such as obesity and diabetes, recent studies also suggest that health coaching is effective for other chronic issues, including stress12 and anxiety,13 low back pain,14 and even oral hygiene.15 Also, in addition to designated health coaches, studies have shown that health coaching practices can be effectively implemented by clinicians, medical assistants, or support staff, especially in small care clinics and group visits.9,16,17

Conclusion

Functional medicine is based on the principle that patients do best with a supportive therapeutic partnership that is collaborative 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 patients’ perceptions of their health and create an individualized therapeutic plan that may include lifestyle changes as part of the treatment. Health coaching is another tool that may help patients sustain those lifestyle changes.

Learn more about enhancing your patient relationships and implementing new tools that help to empower your patients by attending IFM’s Applying Functional Medicine in Clinical Practice (AFMCP). The functional medicine-trained health coaches from the Functional Medicine Coaching Academy (FMCA) work with patients on aligning their modifying lifestyle factors to optimize their health and well-being. Consider adding an FMCA health coach to your care team and learn more about their training and the other added benefits they can bring to your practice.

Learn More About Functional Medicine

Related Articles & Podcasts

Optimizing Outcomes: The Benefits of Health Coaching for Patients and Practitioners

Health Coaches Help Clinicians Achieve Better Patient Outcomes

Health Coaching Helps Patients Help Themselves

Helping Patients Sustain Lifestyle Change With Team-Based Care

Supporting Health in Underserved Populations

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. An S, Song R. Effects of health coaching on behavioral modification among adults with cardiovascular risk factors: systematic review and meta-analysis. Patient Educ Couns. 2020;103(10):2029-2038. doi:10.1016/j.pec.2020.04.029
  4. Long H, Howells K, Peters S, Blakemore A. Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Br J Health Psychol. 2019;24(3):515-546. doi:10.1111/bjhp.12366
  5. 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
  6. 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
  7. Fernando ME, Seng L, Drovandi A, Crowley BJ, Golledge J. Effectiveness of remotely delivered interventions to simultaneously optimize management of hypertension, hyperglycemia and dyslipidemia in people with diabetes: a systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2022;13:848695. doi:10.3389/fendo.2022.848695
  8. 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
  9. 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
  10.  Sherifali D, Brozic A, Agema P, et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: a community-based, randomized, controlled trial. Can J Diabetes. 2021;45(7):594-600. doi:10.1016/j.jcjd.2020.11.012
  11.  Lin CL, Huang LC, Chang YT, Chen RY, Yang SH. Effectiveness of health coaching in diabetes control and lifestyle improvement: a randomized-controlled trial. Nutrients. 2021;13(11):3878. doi:10.3390/nu13113878
  12.  Kus S, Immich G, Oberhauser C, Frisch D, Schuh A. Evaluating the effectiveness of a one-week multimodal prevention program for slowing down and stress reduction performed in a German health resort: results of a randomized controlled trial. Complement Med Res. 2022;29(1):6-16. doi:10.1159/000516025
  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. 2020;18(1):73-83. 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

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