The Impact of Health Coaching on Medication Adherence
The results of this study suggest that medication counseling provided by trained medical assistant health coaches improves medication concordance and increases adherence. To our knowledge, this is the first randomized controlled trial to examine the effect of medication counseling conducted by unlicensed professionals in the outpatient setting. Moreover, in the absence of standard methods for defining and measuring concordance, this study offers a potential method to assess this vital indicator.
The study had several limitations. We investigated concordance only for medications prescribed for the 3 conditions targeted by the study: diabetes, hyperlipidemia, and hypertension. Thus we did not include medications for other conditions or nonprescription (over-the-counter) medications in our analyses. Medication reconciliation was only one of the activities performed by the health coaches; thus identifying which coaching activities improved concordance or adherence is not possible. Medication adherence was assessed by patient self-report and may overestimate true adherence. Although research assistants collected baseline data before study arm assignment and did not have contact with study participants between randomization and the 12-month data collection, they were not actually blinded to study arm assignment, which could have introduced unconscious biases to data collection at 12 months. Finally, the study population comprised low-income patients seen in public safety-net clinics and may not be generalizable to all patients.
Health coaching involves engaging patients in their own care by helping them gain the knowledge, skills, and confidence to become active, informed participants in the management of their chronic condition. These functions of health coaching are similar to the interventions known to improve medication adherence: patient knowledge, patient counseling, and active patient participation. Medical assistant health coaching could prove to be a promising strategy to improve medication concordance and adherence, particularly in resource-poor settings. With a median salary less than a third that of pharmacists, medical assistant health coaches could be a resource for practices who are unable to avail themselves of the help of a pharmacist. Moreover, the medical assistant workforce is more culturally and linguistically diverse than other health professionals and thus may be more concordant with patients. As a result, patients may be more willing to be honest with health coaches about a lack of understanding about, or poor adherence to, medications. There is some evidence that patients may also increase their trust in their primary care provider as a result of working a health coach; trust in a provider is a known predictor of medication adherence. In addition, medical assistants in their health coaching role have more time to spend with patients, assisting them in understanding their medications, engaging them in discussions of adherence, and encouraging them to be actively engaged in their care.