Everyone needs a helping hand... Especially for tackling chronic conditions

March 4, 2016

When it comes to making lifestyle changes to prevent or manage chronic conditions, most of us know the drill—we know what to do, it’s the actual doing that’s the problem. Behaviour-change experts agree that long-lasting change is most likely when it’s self-motivated and based on positive thinking. But just how does a plan member become self-motivated and develop a positive mindset? As we’ve mentioned (a few times), plan members may need a nudge to budge toward self-reliance. Unfortunately, as the health system exists today, and has existed for decades, it is rare that they would get that nudge.

The doctor is helpful, but…

Our premise: Canada is poor at preventing and managing chronic disease. The numbers are poor, and they are predicted to get worse. If the family doctor is your plan member’s first stop for preventing and managing chronic conditions, it probably shouldn’t be their last. For plan members to make important lifestyle changes, they need a more time-consuming, structured approach that involves providing education, motivation, and follow up. However, our traditional doctor/patient model is focused on simply telling us what to do—a disease-treatment focus—rather than actually helping us change behaviour. In addition, the system tends to be reactive rather than prevention-focused.

The nudge they need in the form of health coaching

Research shows that health education on its own—as well as health education combined with peer support—does not typically lead to lasting behaviour change. However, the addition of support in the form of coaching to increase the patient’s skills and confidence in managing their condition and setting realistic goals can be significantly more effective than education alone. This may be the case because central to health coaching is instilling the philosophy of self-management—precisely the component that has been shown to be essential for long-term, consistent behaviour change. As the term coach implies, health coaching is the process whereby a health professional, not specifically a physician:

  • Helps patients to achieve their health goals—whether prevention or management—by motivating and supporting them to
    take responsibility for their progress.
  • Provides support every step of the way from setting realistic goals and overcoming barriers to receiving ongoing follow up.
  • Uses a variety of approaches to support patients; health coaching over the phone and Internet has been shown to be not
    only as effective as in-person coaching but also much more cost effective.

Call it coaching or call it nudging, either way, the outcome is that plan members become self-motivated. And there’s more good news, health coaching is becoming more easily accessible. A range of health professionals—including pharmacists, dietitians, nurses, and exercise physiologists—are increasingly involved in health coaching in a variety of settings.

Health coaching is right around the corner…at the pharmacy

We decided to hit the streets to hear some firsthand accounts of health coaching. Turns out we didn’t have to go far, in fact we didn’t even make it out of the building because first we met up with GSC’s very own Pharmacy Strategy Leader Ned Pojskic. Before joining GSC, Ned worked at the Ontario Pharmacist Association (OPA) and spearheaded a study done in partnership with GSC to examine the impact of a pharmacist-led hypertension management program. If this sounds familiar, it’s because we previously covered the study in The Inside Story®. At the same time, however, pharmacy as a profession is currently undergoing tremendous change as it transitions from a product to a service focus. Some of these changes are putting immense pressure on the traditional pharmacy business model, creating additional time and resource challenges for the delivery of the new services such as health coaching. Until this professional transition process is completed, pharmacies will likely continue to experience challenges in consistently delivering these services to all patients who could benefit from them. Despite some of these challenges, Ned feels that today pharmacist health coaching is more necessary than ever: “Although the beneficial role of pharmacists in disease management—of hypertension, asthma, diabetes, and high cholesterol—has been well documented for over 30 years, there has more recently been a much greater recognition of the value and impact of these services by payers—both public and private. In part, this is due to the fact that we’re facing the perfect storm of factors all pushing the health care system toward change—the aging population, the rising incidence of chronic conditions, the restraints on doctors, the mounting pressures on the health care system from numerous directions, the increasingly complex drug environment…change is a must.”

Is pharmacist health coaching the way of the future—or just a fad?

To answer this question, where better to go for insight than the very place that produces pharmacists. So next we reached out to David Edwards who is the Hallman Director of the School of Pharmacy at the University of Waterloo. Established in 2008, the School of Pharmacy at the University of Waterloo is relatively new—something that David recognizes as an opportunity: “We are able to imagine what the future is going to be like and continually build our program to fit with that future.” David elaborates that a major part of the future is recognizing that “the pharmacist role goes well beyond just dispensing medications; pharmacists are the medication management experts in the health care system. And as medication management experts, there is a major role for pharmacists to play in terms of preventing and managing chronic conditions.” Like Ned, David feels that health coaching is a big part of this role—health coaching is here to stay and grow. Regarding the impact of pharmacist health coaching from the study, Ned explains, “The OPA/GSC study shows a variety of positive outcomes, for instance, that pharmacist health coaching can improve medication adherence and that the pharmacy setting is a natural focal point for a variety of disease management activities. People are going to the pharmacy to fill their prescriptions, so it is just a logical extension that the pharmacist discusses disease management. Interaction at the pharmacy also allows the pharmacist to promote disease prevention, through efforts such as immunizations. As we know, where there is one chronic condition, there is often soon to be two, so if the pharmacist can help control blood pressure, they may also be helping to reduce cardiovascular issues and diabetes.” For more details… To get the full scoop on the study—The Impact on Community Pharmacist Interventions in Hypertension Management on Patient Outcomes: A Randomized Controlled Trial—visit the GSC website at greenshield.ca and check out the February 2014 edition of The Inside Story. continues... 4 Recognizing the significant impact pharmacists can make through health coaching, the University of Waterloo is poised to be a leader. The pharmacy program weaves elements of health coaching into its curriculum. Pharmacy students learn how to help patients understand their condition, set realistic goals, and overcome challenges. So what’s next? Both Ned and David see the pharmacist of the future continuing to engage with patients but in new ways to further emphasize their patient focus. However, this will require developing a business model that makes it possible for pharmacists to provide additional cognitive services and receive reimbursement for their time and expertise.

From the pharmacy to the grocery store…

Next it was off to the grocery store to see another type of health care professional that is actively providing health coaching out in the community. Five years ago, Loblaw Companies Limited started offering a range of dietitian services, as well as their Guiding Star program, which rates the degree that foods are nutritious—three stars is the highest possible rating. Now there are 69 dietitians in Loblaw stores across Canada. Alexis Williams, Senior Director Wellness at Loblaw Companies Limited, explains that there are a wide variety of dietitian services available for people of all ages regarding any nutritional concerns they may have. For example, plan members could take part in a grocery store tour where a dietitian guides them through the aisles educating about healthy food choices. There is also the option of a nutrition check-up, which involves one-on-one nutritional health coaching with a dietitian. As Alexis elaborates, “Each coaching session is completely personalized. First the dietitian conducts a needs assessment that covers health and diet history, and personal nutrition goals. During the next session, based on the assessment and goals, the dietitian provides personalized nutrition recommendations. Then during follow-up sessions the dietitian monitors progress and provides nutritional support until the person meets their goals.” And how have the dietitian services been received? Alexis says that the feedback has been very positive—people are seeing concrete results. Just like it’s effective for pharmacists to provide coaching at the pharmacy, it’s proving effective for dietitians to provide coaching at the grocery store. As Alexis explains, “Providing healthy eating education and support right in the grocery store provides people with practical recommendations that they can act on right away—right on the spot as they do their shopping.”

But is dietitian health coaching just a fad? “Health coaching, like motivational interviewing, has always been a big component of dietitian training and is a skill set that dietitians have always had,” explains Alexis. “I think we will see more instances of dietitian health coaching as our profession continues to emphasize taking a client-centred approach. The dietitian’s goal is to take a collaborative approach to help people, not prescriptive—because education and support is what will help people make lifestyle changes that are sustainable.”

Nudging plan members toward lasting behaviour change

Although our health care system is not currently structured to effectively prevent or manage chronic conditions, health coaching in the community can help nudge plan members toward behaviour change. They can learn to take charge of their own health! All they need is a helping hand… starting at the pharmacy and at the grocery store.

Sources:

1 “Best Advice, Panel Size,” The College of Family Physicians of Canada, 2012. Retrieved February 2016: http://www.cfpc.ca/Best_Advice_Panel_Size/ and “Effects of interventions aimed at changing the length of primary care physicians’ consultation (Review),” Andrew D Wilson, Susan Childs, Cochrane Library, January 26, 2006. Retrieved February 2016: http://onlinelibrary.wiley.com

2, 3, 4 “Canadian patients wait longest to see family doctors,” CBC News, January 20, 2014. Retrieved February 2016: http://www.cbc.ca/news/health/canadian-patients-wait-longest-to-see-family-doctors-1.2501468

5 “Health Care in Canada 2012, A Focus on Wait Times,” Canadian Institute for Health Information, 2012. Retrieved February 2016: https://secure.cihi.ca/free_products/HCIC2012-FullReport-ENweb.pdf