Pulmonary Specialist-Supported Health Coaching Delivered by Lay Personnel Improves Receipt of Quality Care for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Authors

Rachel Willard-Grace, University of California, San FranciscoFollow
Danielle Hessler, University of California, San FranciscoFollow
Beatrice Huang, University of California, San FranciscoFollow
Denise DeVore, Stanford UniversityFollow
Chris Chirinos, independent consultantFollow
Jessica Wolf, independent consultantFollow
Devon Low, independent consultant; patient research partnerFollow
Chris Garvey, independent consultantFollow
DorAnne Donesky, University of California, San FranciscoFollow
Stephanie Tsao, San Francisco Department of Public HealthFollow
David H. Thom, Stanford UniversityFollow
George Su, University of California, San FranciscoFollow

Publication Date

11-27-2023

Keywords

health care quality, evidence-based care, guideline adherence, chronic obstructive pulmonary disease, COPD, health coaching, inhalers, pulmonology, primary care

Abstract

Purpose: Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting.

Methods: As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care.

Results: Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P = 0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P = 0.04) and educational classes (increase of 5.3% over usual care; P = 0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P = 0.06).

Conclusions: Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.

Recommended Citation

Willard-Grace R, Hessler D, Huang B, DeVore D, Chirinos C, Wolf J, Low D, Garvey C, Donesky D, Tsao S, Thom DH, Su G. Pulmonary specialist-supported health coaching delivered by lay personnel improves receipt of quality care for chronic obstructive pulmonary disease: a randomized controlled trial. J Patient Cent Res Rev. 2023;10:201-9. doi: 10.17294/2330-0698.2024