Health coaching and behavior change patient engagement strategies are more effective in the clinic than in home-based settings, researchers found.
Medical providers looking to drive patient engagement in healthy behavior change may consider basing health coaching sessions inside the medical clinic, with clinic-based interventions proving more effective than home- or community-based ones, according to data in JAMA Network Open.
These findings, which were determined prior to the COVID-19 pandemic, come as medical providers work to hone remote chronic disease management strategies.
Healthy behavior change is a key part of chronic disease management. Providers working to keep key metrics under control want to engage their patients in the healthy behaviors that can yield those metrics.
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Patients with HIV, for example, need to have good medication adherence and avoid heavy alcohol consumption to achieve optimal health metrics, the researchers stated. Health coaching in these areas is critical for keeping HIV under control.
The Healthy Choices intervention, which leverages motivational interviewing to keep HIV patients adherent to medication plans and avoiding alcohol consumption, is one of few leading approaches in this area. The intervention dedicates one half of health coaching to improving medication adherence, while the other half focuses on strategies for cutting out alcohol.
However, little is known about how to deliver the Healthy Choices intervention to adolescents and young adults ages 16 to 24 years, a traditionally hard-to-reach population. Some evidence has suggested that community-based health coaching, or health coaching outside of the traditional clinic, can be effective for engaging hard-to-reach populations.
The researchers tested the 10-week, four-session Healthy Choices intervention among this population in both home- or community-based and clinic-based settings, looking specifically at effects on viral load and alcohol consumption.
By and large, the clinic-based Healthy Choices intervention was more effective than the intervention delivered in community- or home-based settings, the researchers gleaned from an assessment of 183 participants.
“Contrary to our hypothesis, the clinic-delivered intervention outperformed the home- or community-based delivery with regard to viral suppression and alcohol severity; it may also be less costly and easier to implement,” the researchers reported.
To be clear, both the clinic- and community-based behavior change interventions were effective in reducing patient viral load and alcohol consumption, the team added. However, it was more effective in the clinic setting.
The researchers observed most of the improvements in viral load during study follow-up. For participants in the home intervention, 21 percent had undetectable viral load at 16 weeks, 22 percent at 28 weeks, and 20 percent at 52 weeks.
Conversely, the clinic-based group saw more sustained improvements. Twenty-four percent of the clinic-based group had undetectable viral load at 16 weeks, 39 percent at 28 weeks, an 35 percent at 52 weeks.
Results were more modest when looking at alcohol use, which the researchers measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). ASSIST scores both alcohol use and severity of use on a 33-point scale.
Generally, the Healthy Choices intervention did not have much of an effect on the frequency of alcohol use, and for those in the home- and community-based cohort is also had little impact on severity of alcohol use.
For those in the clinic-based cohort, the Healthy Choices intervention was effective at reducing the severity of alcohol use, as made evidence during follow-up assessments.
On the whole, the intervention wasn’t broadly successful for every population. There were a notable number of patients who did not make any change in their viral load regardless of their disease state, which could indicate necessary changes to the Healthy Choices intervention in any care site.
“While brief interventions may be more easily implemented in clinic settings, a more intensive intervention may be needed to sufficiently halt viral replication among youths at highest risk,” the researchers posited. “Some youths may benefit from motivational interviewing alone, and some may benefit more from motivational interviewing combined with cognitive-behavioral skills-building interventions.”
Furthermore, future research can look at even more modalities to deliver the Healthy Choices intervention, especially given most study participants did not have perfect attendance to health coaching sessions, both in-clinic and at home.
Researchers may consider looking at the effect of a single Healthy Choices intervention session, or using virtual care options like telehealth for the sessions. Additionally, as the researchers did not explore why clinic-based treatment was better than home-based treatment, this may also be an area of interest.
Those considerations may become more pressing as the healthcare industry grapples with the COVID-19 pandemic, which has put a strain on chronic disease management, among other things.
With more patients reticent to go into the clinic for care, and many providers triaging patients to telehealth-based treatment, understanding the efficacy of care management in different settings will be important.
Source: Patientengagement Hit