Christina Tarantola, PharmD, CHC.
A look at the ways coaching your patients can leave them healthier.
Pharmacists are one of the most accessible health-care professionals.1 Traditionally, pharmacists have taken an active role in educating patients about their disease states, medications, and side effects, and have been involved in medication therapy management (MTM) services for some time.
With the shift from the fee-for-service model to the pay-for-performance model, there is an emphasis on service and quality, which drives needed quality measures. Payment models such as accountable care organizations and patient-centered medical homes will shape opportunities for pharmacists to contribute their services in novel ways.
In recent years, health coaching has become a new opportunity for pharmacists. A health coach is a person who uses evidence-based skillful conversation, clinical interventions, and strategies to actively and safely engage clients or patients in changing their health behaviors. Health coaches are trained to safely guide clients and patients who may have chronic conditions or who may be at moderate-to-high risk for chronic conditions.2
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Not only are pharmacists equipped to help patients with medications, but they are positioned to use health coaching skills, such as motivational interviewing, to empower patients to an optimal state of health.
With changes in quality measures used by the Centers for Medicare and Medicaid Services, physicians are finding it more challenging to create time to discuss and empower patients to adapt healthy behaviors. Pharmacists can help bridge the gap between what the physician tells the patient to do and the actionable steps the patient can take to improve their health. As noted in a study on adherence,3 an overall 40% of patients did not adhere to their doctors’ prescription recommendations. Another 35% neglected to fully follow through on suggested physical therapy directives. Nonadherence to physician-recommended changes in lifestyle habits was 70%.
Every patient can benefit from health coaching. Lifestyle behaviors are the primary reason for many chronic health problems and are the primary cause of death and disability in the United States. Epidemiological data from more than 1.5 million claims indicates that heart disease, cancer, many types of chronic pain, high cholesterol, hypertension, intestinal problems, diabetes, sleeping problems, arthritis, obesity, anxiety, and depression are the leading reasons for medical and pharmacy costs and for absenteeism costs.4
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For some patients, a feeling of disempowerment can substantially impair their ability to implement lifestyle changes and to adhere to medical directives. They need ongoing communication, patient education, and support to achieve the desired results of their drug therapy. Health coaching helps empower patients to take ownership of their health and well-being. Health coaches model key skills related to lifestyle change and personal growth, empowering their clients with a sense of individual mastery and personal accountability.
When it is time for follow-up visits with their health-care providers, patients will be better able to communicate their current efforts if they have met with a health coach. They will also be more confident in opening up to the physician if they discuss potential questions with a coach first.
Studies have demonstrated coaching’s impact in the successful treatment and even reversal of chronic conditions. In one study of patients with prediabetes,5 nearly half of participants returned to normal blood glucose readings following a 14-week personalized coaching intervention. Research also suggests that coaching support makes it more likely that people will successfully lose weight and increase exercise, lower stress, improve lipid markers, decrease blood pressure, and improve diet.
Up next: First, do no harm
As pharmacists, we strive to take the best care of our patients and live by the founding principle of medicine, “First, do no harm.” Through evidence-based lifestyle recommendations, extensive support, and using principles of self determination theory (SDT), we can play an important role in empowering our patients to optimize their health regimen.
The benefits of health coaching are clear, but is health coaching cost-effective? According to a recent report,6 a summary of seven cost analysis studies revealed a $3.48 return on investment for each corporate dollar spent on wellness programming. Patients who receive coaching have an improvement in psychological, physical, and behavioral well-being.7,8 These outcomes are important and relevant to a patient’s quality of life and demonstrate how pharmacists who become health coaches can help make an impact in the larger picture of health care.
Health coaching gives pharmacists a unique opportunity to improve patient care, patient satisfaction, strengthen relationships with local doctors, and add leverage to their pharmacy business. Adding health coaching services can provide a special service to a pharmacy’s clientele and bolster patient trust and rapport.
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There are several educational programs that lead to a certification in health (or health and wellness) coaching or to degrees in the field. These include the Institute for Integrative Nutrition, the National Society of Health Coaches, the Duke Integrative Health Coach Program of Duke Health, and the master’s degree program at Creighton University, to name a few.
At this time, pharmacists do not have provider status in many states and are not eligible for reimbursement from insurance companies for health coaching services. However, patients who understand and see the value of the service may be willing to pay out-of-pocket. Pharmacies can create wellness programs, where patients can be seen in 30- or 60-minute appointments for nutrition and lifestyle consultations. Health coaching skills can also be used during counseling or MTM sessions.
By functioning as a support system for patients and being equipped with effective coaching skills, a pharmacist can have a big impact on patients to lead healthier lives.
1. The Role of the Pharmacist in the Health Care System: Part I: The Role of the Pharmacist in the Health Care System: 4. The Scope of Pharmacy and the Functions of Pharmacists: 4.2 Community Pharmacy. Available at http://bit.ly/1LKIuEE . Accessed on June 16, 2017.
2. Huffman MH. Advancing the practice of health coaching. Workplace Health Safety. 2016; 64 (9): 400–403.
3. Martin LR et al. The challenge of patient adherence. Therapeut Clin Risk Manag. 2005; Sep; 1(3): 189–199.
4. Sforzo GA. The study of health coaching: The Ithaca coaching project, research design, and future directions. Global Health Med. 2014; 2.3: 58-64.
5. American College of Cardiology. “Personalized Health Coaching Helps Reverse Progression to Diabetes.” Available at http://bit.ly/2sOZAUa. Accessed on June 16, 2017.
6. Annand-Keller P, Lehmann D, Milligan K. Effectiveness of corporate well-being programs. J Macromarketing. 2009; 29(3):279-302.
7. Dennis SM. et al. Do people with existing chronic conditions benefit from telephone coaching? A rapid review. Austral Health Rev. 2013; Jun; 37(3):381-8.
8. Kivelä KS et al. The effects of health coaching on adult patients with chronic diseases: A systematic review. Patient Educ Couns. 2014; Nov;97(2):147-57
Christine Tarantola, PharmD, CHC, is a certified health coach. Her website is https://www.thefitpharmacist.com/.