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Health coaches help participants follow their personalized health plan
Patient-centered approach focuses on behavioral change
Duke Integrative Medicine takes health coaching to a new level, providing coaching by highly trained health care personnel who work closely with their clients to help them follow their personal health plan.
"What we do is more than just motivate people to change. It's helping connect their behavior to their values and to what matters most to them," says Julie Kosey, MS, CPCC, ACC, integrative health coaching manager at Duke Integrative Medicine.
It is the first major academic medical center to develop a specified role for the health coach on the clinical team. And the program's success was demonstrated in a study of 154 outpatients with one or more known cardiovascular risk factors who received a personalized health plan and worked with a health coach to set and achieve goals.
At the end of the 10-month study, participants experienced a reduction in risk for coronary heart disease as measured by the Framingham risk score.
A health coaching program tailored for a subset of high-risk Duke employees and their dependents resulted in fewer hospitalizations and lower emergency department costs for those who would have qualified for the program but did not participate, says Ruth Wolever, PhD, director of research at Duke Integrative Medicine and assistant professor of psychiatry at Duke Medical Center.
Health coaching meet personal coaching
"Health care has long been about treating disease to return a person's body and mind to an acceptable state of health, and separately, people have sought the support and guidance of coaches to help them move to new levels. Health coaching brings these two worlds — health coaching and personal coaching — together," Kosey adds.
Integrative medicine combines state-of-the art medical treatments and evidence-based complementary therapies and focuses on the whole person, rather than a disease or condition to help the patient achieve optimal health. In addition to traditional Western medicine therapies, such as treatment by physicians and prescription medicine, participants in integrative medicine programs may receive services including physical therapy, nutritional therapy, movement and exercise, health psychology, stress reduction and mind-body interventions, botanicals, and acupuncture.
"Our mission at Duke Integrative Medicine is to be a catalyst to shift the way that health care is practiced, to move to a more patient-centered approach," Wolever says.
During what is called an "immersion experience," each patient collaborates with physicians and other health care professionals and develops a plan tailored to his or her needs, then works with the health coach to reach the goals set out in the plan.
The depth of the program is what distinguishes Duke Integrative Medicine's health coaching from those offered by other entities, Wolever says.
"I presented at a teleconference with several disease management entities. At the end, someone asked the typical caseload of each program. One said 250, another said 500. Our health coaches work with no more than 30 people at a time," she adds.
"Often people have a lot that they need to do to become healthy. They want to work on some of [those things] and they don't want to work on others. One thing the integrative health coaches do better than traditional health care providers is stay focused on what is important to the client," she says.
The multidisciplinary team at Duke Integrative Medicine includes physicians, nutritionists, exercise physiologists, and health coaches as well as ancillary services such as psycho-social services, acupuncture, and massage therapy.
Participants in the integrative health coaching program become involved in a number of ways.
During the immersion experience, participants work with a variety of disciplines over a three-day period, then work closely with a health coach to follow the personalized health plan the multidisciplinary team recommends.
"There are multiple pages of suggestions. This is overwhelming for most people. Together we create a plan that helps them choose what is most important to them out of the whole big picture. The plan shifts and changes as they try out different things," she says. The integrative medicine center offers enrollment programs that include consultations with the health care team, coaching sessions, and personal health plans as well as personalized group programs for businesses, families, and groups as well as day and half-day programs.
"The concept of this program is to empower the patient through education and skill building. It's a holistic program that gives patients access to providers with different views who can help them create a health plan," Wolever says.
When participants enroll in the health coaching program, the coaches help the participants identify what they want to work on and to be specific and look at how the changes they want to make would influence their life as a whole, Kosey says.
In most situations, the participant and the health coach develop specific goals in each session and discuss what worked and what didn't the next time they talk.
It's not all or nothing
"Health coaching is all about helping people identify what is important to them and how they can go about it. The most critical piece of the process is whether the person is ready to make the changes. So many people see their physician who may say that the most important thing they can do is quit smoking. They're not ready to do that, so they don't do anything," Kosey says.
For instance, when a health coach meets with a smoker, if that person says they want to start walking for exercise, the health coach helps them get started in the process.
"There's often a ripple effect. They start walking and find they are short of breath and this encourages them to stop smoking," she adds.
The participants may want to have the energy to play with their grandchildren, or to be around for their daughter's wedding, or to be able to climb a mountain. Whatever their goal, the health coach helps them reach it.
"A lot of health coaching through occupational health or health insurance has a disease-management focus, such as encouraging patients to manage their blood sugar and report the results the next week. What we are doing is to help the person understand what differences it would make in their life if they got their diabetes under control. Integrative health coaching is not just about accountability but helping the person learn about themselves. We help them engage in personal reflection in addition to, or instead of, a specific action," Kosey says.
Individual coaching sessions are typically 30 to 40 minutes in length. Group coaching sessions are an hour in length and may take place in person or over the telephone via conference calls.
The integrative health coaches have master's degrees in health promotion or behavioral change, such as health psychology and are trained in how to help people change the way they relate to the world and how they behave.
Duke Integrative Medicine provides training for the coaches on motivational interviewing, assessing readiness to change, and on mindfulness along with clinical training that gives them the knowledge to work with members of the interdisciplinary team.
The coaches are trained to recognize symptoms that indicate that people need to seek medical care.