Aides in Respiration Health Coaching for COPD
Condition: Chronic Obstructive Pulmonary Disease (COPD)
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      This study examined whether health coaches can improve the management of chronic obstructive
      pulmonary disease (COPD) in a population of vulnerable patients cared for in 'safety-net'
      clinics. The study is designed as a randomized controlled trial for patients with moderate to
      severe COPD. Patients were randomized into a health coaching group and a usual care group.
      Those in the health coaching group received 9 months of active health coaching. Outcome
      variables were measured at baseline and after 9 months
    

Detailed description: 
      Health coaching is a promising model for improving evidence-based care for patients with COPD
      which had not been evaluated at the time the current study began in 2014. Health coaching by
      health workers or peers trained as coaches, has emerged as an effective model to improve
      these management domains for children with asthma and adults with diabetes, and hypertension
      receiving care in urban safety-net clinics. The role of the health coach includes many of the
      activities also provided by patient navigators, patient educators, and community health
      workers. Health coaching is a patient-centered model that recognizes that that people living
      with chronic disease are the primary decision-makers in their care; it is a tailored approach
      that builds on the strengths and expertise of patients and helps to ensure that they have the
      knowledge and skills to be active participants within the medical encounter and to
      effectively manage their conditions. Incorporating health coaches into care delivery fits
      well with the of integrated care model recommended by the American Thoracic Society which is
      based on the Chronic Care Mode. Health coaching can work on several components of the Chronic
      Care Model as it applies to COPD to enhance the effectiveness of care delivery and promote
      patient goals. Health coaches provide decision support by helping execute customized care
      plans jointly developed by patients and providers. Coaches track care targets and conduct
      'gap analysis' to identify areas which are sub-optimal. Coaches also help patients to get the
      support they need by facilitating access to community, clinic, and specialist support,
      improving communication between patients and providers, working with patients to set goals
      and develop action plans to reach those goals. The goal of our study was to evaluate the
      effectiveness of a health coach model for improving outcomes for low-income urban patients
      with COPD. We conducted a randomized trial comparing 9 months of health coaching plus usual
      care (health coached arm) to usual care (usual care arm) alone for patients with moderate to
      severe COPD cared for at 7 federally qualified health centers (FQHCs). The specific aims of
      the study were:

      Specific Aim 1. To compare disease specific quality of life for patients randomized to
      receive 9 months of health coaching plus usual care to those randomized to usual care alone.
      Our hypothesis was that mean quality of life, assessed by the Chronic Respiratory Disease
      Questionnaire total score and dyspnea domain score at 9 months, would be greater in patients
      in the health-coached arm when tested against the null hypothesis of no difference between
      health-coached and usual care patients.

      Specific Aim 2. To compare the number of exacerbations of COPD experienced by patients in the
      health coached arm to those in the usual care arm during the 9 month period starting at
      enrollment. COPD exacerbation was defined as an emergency department visit or hospitalization
      for COPD-related diagnosis or the outpatient prescription of oral steroids for COPD-related
      diagnosis. Our hypothesis was patients in the health-coached arm would experience fewer
      exacerbations when tested against the null hypothesis of no difference between health-coached
      and usual care patients.

      Specific Aim 3. To compare exercise capacity at 9 months for patients in the health-coached
      arm to those in the usual care arm. Our hypothesis was that patients in the health-coached
      arm would have greater exercises capacity as measured by the 6-minute Walk Test when tested
      against the null hypothesis of no difference between health-coached and usual care patients.

      Specific Aim 4. To compare self-efficacy for management of their COPD for health-coached
      versus usual care patients at 9 months. Our hypothesis was that mean self-efficacy, as
      measured by Stanford Chronic Disease Self-Efficacy Scale would be greater in patients in the
      health coached arm when tested against the null hypothesis of no difference in self-efficacy
      between health-coached and usual care patients.
    

Intervention name(s): Health Coaching
Intervention type(s): Behavioral
Intervention description(s): Patient COPD education; Correct use of inhalers and nebulizers; Red flags and when to seek medical care; Dyspnea management; Patient decision making and action plans around, exercise, smoking cessation; nutrition, exacerbations; Ensuring appropriate preventive services (pneumovax, flu); Depression screening; Reinforcing clinician education and use of treatment guidelines by primary care providers; Identifying gaps in care, areas where care not in line with care plan; Facilitating communication between patients, pulmonary specialists and primary care providers; Connecting with community resources; Access to psychosocial services; Working with pulmonary specialist to provide recommended exercise program; Working with patient family members and caregivers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Chronic Obstructive Pulmonary Disease; Health Coaching; Health Disparities; Self-management; Chronic Disease Model