Featured Articles                                                   July 2010, Vol. III, No. 3
Community-Based Lifestyle Intervention Yields Weight Loss,
Compared to Individual Counseling

A community-based lifestyle intervention program, modeled after one used in a landmark government funded diabetes-prevention study, can help participants in a group setting achieve weight loss and blood glucose reductions comparable to those achieved with individual counseling from health professionals, according to data presented by researchers at the American Diabetes Associationís 70th Scientific Sessions®.

In the Healthy Living Partnerships to Prevent Diabetes (HELP PD) study, participants were divided into two groups: a lifestyle weight loss group, which received six months of weekly behavioral weight loss sessions in a group setting, followed by monthly follow-up meetings, at which they were encouraged to change eating behaviors and exercise up to 180 minutes per week; and a usual care group, which received two visits with a dietitian and a quarterly newsletter with tips for lifestyle changes. The group weight loss sessions were delivered by lay community health workers trained and supervised by dietitians at the Wake Forest Diabetes Care Center in Winston-Salem, N.C. The HELP PD model relies upon DVDs developed by the research team that give participants information about healthy eating, proper stretching and exercise tips, how to eat "mindfully" (i.e. not out of boredom or habitually in front of the television) and other lifestyle-related topics. Dr. David Goff, chair of the Department of Epidemiology and Prevention at Wake Forest University School of Medicine, said that training community health workers to coach participants on how to set goals, solve problems and use the information in the DVDs could be accomplished by others interested in starting such a program in their own community. However, reimbursement for these programs is a barrier.

The HELP PD study found that those in the lifestyle intervention group achieved and maintained significantly greater weight loss (an average of 7.3 percent of body weight) than those in the regular care group (who achieved an average loss of just 1.3 percent of body weight) after 12 months. The lifestyle intervention group also reduced blood glucose levels by an average of over 4 mg/dl, from 105.8 mg/dl to 101.2 mg/dl, after 12 months, compared to an average drop of less than 2 mg/dl (to 104 mg/dl) for the regular care group. The results for the lifestyle group mirrored those achieved over three years by participants in the landmark National Institutes of Health-sponsored Diabetes Prevention Program (DPP), in which individuals with glucose levels in the pre-diabetic range were able to reverse the course of their disease by losing 5-7 percent of body weight and exercising 150 minutes per week, in addition to receiving individual counseling sessions with trained behavioralists. In the DPP, the weight loss program led to a 58 percent reduction in the development of diabetes, from about 11 percent a year to about 5 percent a year.

According to Dr. Goff, "In the DPP, professional behavioral specialists worked with participants with pre-diabetes in one-on-one sessions. We trained some of our patients with diabetes to work as lay community health workers with groups of participants with pre-diabetes, so we didnít expect to see quite as good a weight loss result as we did. Given that our weight loss results look as good as the DPP, this approach shows great promise for preventing diabetes. Itís a translatable intervention to deliver in public health settings. This approach could be replicated at diabetes care centers across the country." There are more than 3,000 such centers in the United States, with on-site physicians, diabetes educators and facilities that can be used for delivering the type of group intervention employed in this study.

Get more information here.

Quotable: Relapse in Behavior Change

"During relapse — which is a normal part of behavior change — it is extremely important for the coach to continue to build self-efficacy in the fact that the client is learning. You help the client debrief, talk about, understand, shift their perspective on the relapsed behavior and renew wherever they are in the change process. Importantly, as part of helping normalize and reframe relapse as an understandable, predictable part of this process, the key is to help the individual stay accountable and yet avoid getting into a shame loop that will almost certainly take them farther off course."
                                        — Dr. Ruth Wolever, Duke Integrative Medicine.

Learn more about health coaching for behavior change.

Patient Transition Coaching Program to Reduce Readmissions

Alicare Medical Management has expanded an existing program to reduce readmissions and help patients make a safe and effective transition from the hospital to their homes. AMMís telephonic Patient Transition Coaching Program is specifically intended to address the post-discharge needs of patients who are at risk for hospital readmission. Typical patients for AMM's program would be those discharged post surgically, as well as patients with congestive heart failure, chronic obstructive pulmonary disease and various cardiac conditions.

AMM's telephonic Patient Transition Program service begins with outreach by one of AMM's RN health coaches. Immediately after patients leave the hospital, they are contacted by an RN health coach who assesses their health status and identifies any potential problem areas. A key role of the RN health coach is to make certain patients are properly informed about essential follow-up care and self-management requirements, have their medications and understand when and how often to take them, are properly educated about potential problems, and know when to reach out to their physician. When appropriate, the RN health coach will contact the physician for additional information, intervention and to coordinate follow-up care. The program is available on a standalone basis or in conjunction with AMM's utilization management programs. AMM can work with clients to develop referral criteria to identify appropriate cases for their patient population.

"Recent studies document that as many as 20 percent of patients discharged from hospitals end up back in the hospital within 30 days," according to researchers. "Many of these costly readmissions result from a lack of follow-up care or the patient's inability to understand and follow their physicianís directions. With proper care coordination following discharge, many of these costly readmissions can be prevented." Under the recent federal healthcare reform legislation, the Patient Protection and Affordable Care Act, reducing readmissions was identified as a key cost management initiative, even mandating reductions in Medicare payments for preventable hospital readmissions.

Read the full article here.

Health Coaching in Primary Care
Susan Shepard, director of patient safety education for The Doctors Management Company, shares the latest literature on the causes and prevention of hospital readmissions. She describes the type of patient most at risk for readmission, some of the risks inherent in transitioning patients from one care site to another, and the contribution of the patient's primary physician to a successful discharge.

Listen to the podcast here.

New Chart: Key Steps in the Hospital Discharge

The hospital discharge provides many opportunities to tighten care transitions and confirm the patient's understanding of the plan of care. We wanted to see which critical steps were being performed at the hospital discharge to reduce the likelihood of readmission.

Click here to view the chart.

Health Coaching in Pharmacy Outreach Programs

Question: For your polypharmacy program, describe in more detail individual counseling at the pharmacy level. How are individuals identified, and how did you work with the pharmacist to provide this type of counseling?

Response: We identified members by the number of medications they were on. We reviewed data over the year to determine who had been on five or more medications for at least a three-month period. We also pulled members based on the Beers criteria. Dr. Beers is a well-known geriatrician out of Philadelphia. He has published extensively on medications that put older adults at risk for falls and other adverse events. We gathered pharmacists by asking our internal pharmacists which local pharmacists they worked with and with whom they had fantastic relationships. I also went to a number of colleges and asked their best gerontology pharmacy educators to participate as well. Everyone got together to ensure consistency in how we would use the warning sheets, what the content would be, the expectations of the counseling visits and the resources available to the pharmacist when the issues exceeded their area of expertise, such as nutrition, function or finances.

(Danielle Butin, founder and executive director of Afya and former director of Northeast Health Services, Secure Horizons, a division of UnitedHealthcare.)

Learn more about counseling at the pharmacy level as well as care transition coaching.

HCH Readers Save 10% on Coaching Resource

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Get more information on improving medication adherence.

2010 Benchmarks in Obesity and Weight Management

This white paper captures the top strategies organizations are implementing to prevent and reduce obesity and related conditions and costs, based on responses from 131 healthcare organizations to the April 2010 Healthcare Intelligence Network Obesity and Weight Management e-survey.

Download complimentary white paper here.



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