Abstract P098: Feasibility Of Training Primary Care Staff To Conduct Weight Maintenance Coaching Through The Electronic Health Record During Routine Clinical Work: Initial Results From The Maintain Prime Study
Authors: Maribel Cedillo, Jesell Zepeda, Bernadette Kiraly, Michael Flynn, Charlene Weir, Teresa Taft, Emily Zheutlin, Polina Kukhareva, Kensaku Kawamoto, Molly B Conroy
Journal: Circulation (2022)

Introduction: Obesity is a significant health problem in the US. Sustainable interventions are needed to support longer-term maintenance after weight loss. We designed and tested a successful electronic health record (EHR)-based weight maintenance intervention with coaching delivered by research staff. Our next step is to determine whether coaching can be done by primary care staff during routine clinical work. We address 3 feasibility questions for using staff as coaches: coach recruitment, efficiency and effectiveness of coach training, and workflow integration and burden. Methods: MAINTAIN PRIME is an RCT comparing EHR-based coaching plus tracking vs tracking alone for primary care patients with recent weight loss. Implementation in 2 pilot clinics included: 1) approval of clinic leaders; 2) advertising to clinic staff for volunteers; 3) development and delivery of a self-paced coach training program; 4) coaching pilot patients for one month. Training (with a $400 one-time stipend) consisted of: 1) in-person orientation; 2) six core interactive online learning modules; 3) in-person review session; and 4) hands-on EHR tool training. Topics included weight management and behavior change, online communication, and structure of coaching messages. We obtained quantitative and qualitative feedback for both training and pilot coaching experience. Results: Recruitment: All clinical leaders (n=9) agreed to staff participation. Thirteen (10 medical assistants (MAs), 2 nurses, and 1 care manager) volunteered, out of 96 total clinical staff. Training : Six (46%) staff completed training. Reported confidence was very high (4.6/5) after training and the likelihood of recommending training to others was moderate (6.8/10). A common theme to improve training was to consolidate; we eliminated in-person review and added case studies to online modules. Staff found hands-on EHR tool training and research team support most valuable components of training. Coaching Experience: Integration of coaching into routine clinic work varied extensively, with some coaching throughout the day, and others saving it for end of day or once a week. All reported that coaching was easy to do with tools provided and took between 10-20 minutes/day. Most believed that they could coach between 10 to 20 patients at a time. Confidence levels were high (5.8/7) while coaching and belief in usefulness of coaching was very high (6.4/7). Of the 6 coaches trained, 3 elected to continue coaching after pilot conclusion. Conclusions: Coaching by primary care staff appears to be feasible with clinical leaders supporting staff engagement and staff coaching during routine clinical work. The training program was well received and reported to be effective by coaches both right after the training and during coaching. The relatively low volunteer levels and coach attrition may be barriers and further incentives may need to be considered.