Impact of Coaching Patients on Coronary Risk Factors: Lessons from The COACH Program
Margarite J. Vale
Michael V. Jelinek
James D. Best
It is well recognized that there is a treatment gap in the management of risk factors in patients with coronary heart disease (CHD) - a gap between what is known from published evidence and what is actually practiced. Strategies to address the treatment gap have usually been aimed at the physician and these have often been ineffective. Few strategies have been directed at the patient. Patient-targeted strategies can be subdivided into those that permit the prescribing of medication by allied health professionals and those where allied health staff do not have prescribing rights. Although intuitively it may appear that any program providing attention to patients would result in improvements in risk-factor levels, published work shows that the programs that allow the prescription of drugs have all resulted in significant improvement in coronary risk factor status. By contrast, all but one of the non-drug prescribing programs failed to improve the risk factor status. The COACH (Coaching patients On Achieving Cardiovascular Health) Program is a novel program using non-drug prescribing health professionals to achieve the target levels for all of the modifiable risk factors in patients with CHD. The COACH Program is a training program for patients with CHD in which a health professional coach trains patients to aggressively pursue the target levels for their particular coronary risk factors. The coach is hospital-based and uses the telephone and mailouts to provide regular coaching sessions to patients after discharge from hospital. Coaching is directed at the patient and not at the treating doctor. Patients are coached to know their risk-factor levels, the target levels for their risk factors, and how to achieve the target levels for their risk factors. Patients are persuaded to go to their own doctor(s) and ask for appropriate prescription of medication(s). Coaching also trains patients to follow appropriate lifestyle measures. The COACH Program has been validated by two randomized controlled trials. The first was a pilot, single-center study in which one coach targeted serum cholesterol as an outcome. Having established the success of the method, a definitive multicenter study was performed in six hospitals, each with its own trained coach, which aimed to improve lipid and other risk factors. This study confirmed that coaching was an independent and significant factor in lowering total and low-density lipoprotein cholesterol. In addition, coaching resulted in a lower blood pressure, lower intake of dietary saturated fat, lower bodyweight, less anxiety, improved self-perception of health, and lesser symptoms of chest pain and breathlessness at 6-month follow-up. The COACH Program is a proven, highly effective method of using health professionals, who do not have the authority to prescribe medication, to improve risk status in patients with CHD.
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