The Impact of Health Coaching on Medication Adherence
Background Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence.
Methods This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care.
Results Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P < .001).
Conclusions Health coaching by medical assistants significantly increases medication concordance and adherence.
Poor use of prescription medications results in $213 billion of avoidable costs to the US health care system each year, with $105 billion ascribed to medication nonadherence and $20 billion to medication errors. On average, 50% of medications for chronic conditions are not taken as prescribed, resulting in poor clinical outcomes. Adverse medication effects caused by lack of agreement (concordance) between medications prescribed and medications actually taken are also a serious problem.
Medication concordance refers to the level of agreement between one list of medications, such as medications reported by patients as being prescribed, and the list of medications prescribed in the medical record. Concordance differs from adherence in that patients may report medications as being prescribed but still not take them as prescribed (nonadherence). Medication reconciliation refers to comparing 2 lists of medications to create a common list of medications. Studies of medication reconciliation have commonly looked at agreement between lists of outpatient and inpatient medications at the time of hospital admission or discharge or between a list of patient-reported medications and the medication list in the medical record. Studies of medication concordance in the outpatient setting have generally been cross-sectional and descriptive. The few published studies of medication reconciliation to increase concordance and/or adherence in the outpatient setting have used historic or nonrandomized controls or have relied on clinical pharmacists who provide bundled pharmaceutical services, of which medication reconciliation was only one part. Pharmacists are not generally available in many health centers because of their high cost and challenges to reimbursement for services in many states; for example, to date only 2% of federally qualified health centers have a pharmacist on staff.*
A number of factors contribute to poor medication concordance and adherence, including poor understanding among patients of which medications they should take and how they should be taking them. Health coaches are increasingly used in primary care and other settings, primarily to help patients improve control of one or more chronic conditions, and they may provide an important resource to improve medication concordance and adherence and thereby reduce medication errors. In our model health coaches are medical assistants who work in the clinic and have received additional training that includes training in medication reconciliation, adherence counseling, and collaborative communication. However, little is known about whether medication counseling conducted by unlicensed professionals in the outpatient setting improves medication concordance and adherence. We investigated the impact of medication counseling provided by health coaches on medication concordance and adherence in the context of a randomized controlled trial of health coaching versus usual care for patients with uncontrolled diabetes, hyperlipidemia, and/or hypertension.
Abstract and Introduction
Abstract
Background Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence.
Methods This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care.
Results Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P < .001).
Conclusions Health coaching by medical assistants significantly increases medication concordance and adherence.
Introduction
Poor use of prescription medications results in $213 billion of avoidable costs to the US health care system each year, with $105 billion ascribed to medication nonadherence and $20 billion to medication errors. On average, 50% of medications for chronic conditions are not taken as prescribed, resulting in poor clinical outcomes. Adverse medication effects caused by lack of agreement (concordance) between medications prescribed and medications actually taken are also a serious problem.
Medication concordance refers to the level of agreement between one list of medications, such as medications reported by patients as being prescribed, and the list of medications prescribed in the medical record. Concordance differs from adherence in that patients may report medications as being prescribed but still not take them as prescribed (nonadherence). Medication reconciliation refers to comparing 2 lists of medications to create a common list of medications. Studies of medication reconciliation have commonly looked at agreement between lists of outpatient and inpatient medications at the time of hospital admission or discharge or between a list of patient-reported medications and the medication list in the medical record. Studies of medication concordance in the outpatient setting have generally been cross-sectional and descriptive. The few published studies of medication reconciliation to increase concordance and/or adherence in the outpatient setting have used historic or nonrandomized controls or have relied on clinical pharmacists who provide bundled pharmaceutical services, of which medication reconciliation was only one part. Pharmacists are not generally available in many health centers because of their high cost and challenges to reimbursement for services in many states; for example, to date only 2% of federally qualified health centers have a pharmacist on staff.*
A number of factors contribute to poor medication concordance and adherence, including poor understanding among patients of which medications they should take and how they should be taking them. Health coaches are increasingly used in primary care and other settings, primarily to help patients improve control of one or more chronic conditions, and they may provide an important resource to improve medication concordance and adherence and thereby reduce medication errors. In our model health coaches are medical assistants who work in the clinic and have received additional training that includes training in medication reconciliation, adherence counseling, and collaborative communication. However, little is known about whether medication counseling conducted by unlicensed professionals in the outpatient setting improves medication concordance and adherence. We investigated the impact of medication counseling provided by health coaches on medication concordance and adherence in the context of a randomized controlled trial of health coaching versus usual care for patients with uncontrolled diabetes, hyperlipidemia, and/or hypertension.
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