Managing chronic disease successfully is a practice in vigilance. It requires disciplined care, ongoing attention, a thorough understanding of the illness and its aggravators, and often times a major adjustment to a patient’s lifestyle. Close to half of American adults suffer at least one chronic disease, but coinciding with those rising rates of illness is primary care physician scarcity, especially in rural areas. This presents an additional hardship for patients with one or more long-term illness, particularly those who need guidance, whose condition demands monitoring, or those whose medication nonadherence presents a danger which should be prevailed upon. This is why health coaches are a proven advantage for patients living with chronic disease. Health coaching can be the safety net which catches patients and their evolving concerns, who would otherwise fall through the gaps in care.
Having a chronic disease can feel disempowering. Patients make choices around or accommodating the illness, which can feel like life is governed by a malady. Compounding that alienation is the fragmentation of provider care. When patients do have access to care it’s not necessarily coordinated care; patients may be shuffled around to multiple doctors between rotating venues, depending on the nature of their visit, who are unfamiliar with the patient’s full narrative. More so when they suffer comorbid diseases, which 1 in 4 adult Americans do. Some patients may feel they have no advocate, and don’t know how to advocate for themselves.
Coaches empower patients
Coaches arm patients with the cognitive tools to manage their health and the self-assurance to be an agent in their own care. An abrupt change of lifestyle can be a significant adjustment for patients with a recent diagnosis, but coaches translate the new language of their illness and the healthcare sphere. Professor and director Kate Lorig of Stanford School of Medicine’s Patient Education Research Center explained to the Wall Street Journal that coaching “is systematically giving people the confidence that they can do something and succeed.” Coaches establish and maintain relationships with patients, know their conditions as well as the variables which impact their disease, and offer treatment suggestions based on patient data, all the while communicating this information to the patient for the benefit of self-management.
Much of self-managing a chronic disease revolves around medication adherence. Only 50% of patients with ongoing illnesses take their prescriptions as directed, costing between $100 and $300 billion in “avoidable healthcare costs”, annually. Medication noncompliance can have alarming long term health consequences- for example, the potential complications of type 1 diabetes due to mismanagement can include kidney failure, blindness, lower extremity amputation, and death. Reasons for medication noncompliance range from health literacy and affordability, to fear of side effects or depression (often a comorbid of chronic disease). Depression not only worsens quality of life, health, and job performance for patients with chronic disease, but is sometimes not recognized by physicians, because symptoms are attributed to their long term illness or slip through the cracks of uncoordinated care. Patients may not fully understand the future implications of medication nonadherence, but coaches can illustrate the entire picture for patients.
Coaching benefits are proven
While coaching is a fairly new facet of disease management, the benefits are proven. In one study which tracked the value of health coaching on diabetic patients, the amount of patients who achieved the “clinical goal” A1C nearly doubled. The YMCA conducted a preventive coaching program for prediabetic patients and found that their 42,000 participants lost an average of 5.5% of their body weight after the first year in the program. CVS Health announced last month that it is instituting a diabetes coaching program, Transform Diabetes Care, to better patient health and reduce medical costs ($3,000-$5,000 annually per member) by improving medication adherence and lowering A1C levels, with no financial burden to patients. They will receive a cloud connected glucometer, prescription reminders, and interventions from coaches when unhealthy trends are recognized.
Peer coaching is also gaining traction, and being leveraged for patients suffering substance misuse disorders. Robert Lubran, former director of the Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration explained “We [in the substance abuse community] certainly see addiction to a whole set of substances as a chronic condition…There’s a growing body of evidence that it is not an acute condition, so much as a long standing chronic disorder that requires lengthy treatment.”
Medicaid has started to cover peer coaching services like Ascent for patients coming out of drug courts and treatment facilities in New York, Tennessee, and Ohio. In Massachusetts, a pilot treatment network for recovery called Gosnold has found success, boasting an 83% reduction rate in recovery facility readmissions during the one year program which offers intensive coaching. Of their 54 adult patients, only one was admitted to the ER (compared to the 16 the year proceeding the program). It’s estimated that Gosnold saved Massachusetts 37% in rehabilitation expenditures. Some peer coaches establish their relationship with patients as early as their ER admission for an overdose, a compassionate and understanding port in the storm.
Peer coaches offer something most healthcare providers cannot—personal experience. They can relate to patients and more importantly, serve as an example that recovery is possible; that there’s life after addiction.
When the healthcare system feels impersonal, or disease management daunting, coaches can be a lifeline for patients. They do more than just advise; they forge a connection with patients, and equip them with the education to act as an arbiter in their chronic disease management, rather than its collateral. Though the future of healthcare in America is uncertain, informed patients who champion themselves stand to mitigate the unpredictability of their ongoing illnesses.