Prevention 2014: Health Coaching to Motivate Lifestyle Change

1. 1© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Health Coaching to Motivate Lifestyle Change Ruth Q. Wolever, PhD Dept of Psychiatry & Behavioral Sciences Research Director, Duke Integrative Medicine

2. 2© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Disclosure Chief Scientific Advisor for eMindful

3. 3© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Setting the Stage… “Health and wellness coaches will help catalyze a transformation in healthcare. The time is now for a new model of care--one that is relationship-centered and prevention focused, and health and wellness coaches are leading the way.” --Pamela Peeke MD, MPH, national spokesperson for the American College of Sports Medicine’s “Exercise is Medicine” campaign, and advisor to the U.S. Surgeon General--

4. 4© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Background: Need 4 • Health behavior-related chronic diseases are leading to a crisis in health care, and public & private finances • Current healthcare system was designed to manage acute disease and not chronic health- behavior related disease • Health professionals are not trained and reimbursed to support patient engagement and health behavior change as a means to treating and preventing chronic disease

5. 5© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Who is trained to support behavior change? 5 • Many professionals refer to their work as “coaching” • No agreed upon practice guidelines nor standards for training and education Wolever, R.Q. & Eisenberg, D.M. (2011, Oct 10). What is Health Coaching anyway? Standards needed to enable rigorous research. Invited Commentary, Archives of Internal Medicine, E7-E8 …… yet

6. 6© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center What is health and wellness coaching? Wolever, Simmons, Sforzo, et al (2013). A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral Intervention in Healthcare, Global Advances in Health and Medicine, 2(4), 34-53.

7. 7© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Frequency of Articles on Health & Wellness Coaching Across Time 0 50 100 150 200 Thru 2003 2004-2006 2007-2009 2010-2012 NumberofArticles Publication Years Wolever, Simmons, Sforzo, et al (2013). A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral Intervention in Healthcare, Global Advances in Health and Medicine, 2(4), 34-53.

8. 8© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Systematic Review of 284 Peer-Reviewed Articles Showed Key Aspects of Definition of Health Coaching (n = # articles with adequate info to rate this aspect) Yes/partially Patient-centered (n=228) 196 (85.9%) Patient-determined Goals (n=217) 153 (70.5%) Self-discovery (n=188) 119 (63.3%) Accountability (n=196) 168 (85.7%) Content education (n=233) 212 (91.0%) Consistent Relationship (n=154) 120 (78.0%) Wolever, Simmons, Sforzo, et al (2013). A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral Intervention in Healthcare, Global Advances in Health and Medicine, 2(4), 34-53.

9. 9© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center HC Distinctions Health Education & Counseling Medical model Diagnosable illness in paradigm of pathology Focus on fixing a problem Professional as expert “Why” questions with present and past focus Restore client’s level of functioning Health Coaching Learning/development model Desirable goals & achievement in paradigm of possibility Focus on optimal performance Coach as non-judgmental partner of equal stature “How” questions with present and future focus Move client to personal fulfillment or optimal performance Wolever et al (2011). Integrative health coaching. Explore, 7(1), 30-36.

10. 10© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Health Coaching is Based on…. • 80+ yrs psychology research that demonstrates key features to human motivation, how adults learn, and sustain change: • growth-promoting relationships • importance of personalized vision • relationship of goal selection to an individual’s core values and sense of purpose • Patients are life-long learners whose individual values, sense of purpose and capacity for interpersonal connectedness facilitate their potential for change.

11. 11© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center 25+ Years of Behavioral Science • Behavioral medicine research – Interventions must provide skills; education is necessary but far from sufficient – Addition of active problem-solving skills and self-discovery to integrate learning – Motivational Interviewing style of counseling • These approaches focus not on pathology, but on behavior change

12. 12© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Emerging Field of Behavioral Economics • Helps us to understand role of contextual factors in decision making • Useful for engagement and habit formation • However, must tap deeper levels of motivation to sustain change in current environments

13. 13© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Our Key IHC Effectiveness Studies ■ RCT of 154 primary care outpatients at elevated risk of CVD found 10 month HC program to lower 10 year predicted morbidity of heart disease faster and more significantly than control group Edelman et al. (2006). Journal of General Internal Medicine

14. 14© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Our Key Effectiveness Studies RCT of 56 diverse outpatients with T2D found 6 mos of IHC to improve ■ patient activation ■ medication adherence ■ exercise ■ social support ■ benefit-finding ■ glycemic control in those who started with poor control Wolever et al., 2010, Diabetes Educator • When control group given IHC, also saw pharmacy claims-based medication adherence

15. 15© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center  174,120 subjects with selected chronic conditions, preference-sensitive conditions & high care costs  Randomized to usual-support group or health coaching  Primary outcomes: total medical costs and resource utilization (e.g., hospital admissions)  After 12 mos, ave pmpm medical & pharmacy costs 3.6% lower ($7.96) in health coaching group vs usual-support, p=0.05  Majority of savings from 10.1 % reduction in annual hospital admissions and some savings from decreased use of emergency rooms.  The cost of the HC program was < $2.00 pmpm Wennberg et al, NEJM, 363(13), 2010 (and Supplementary Appendix)

17. 17© (Copyright) 2008 Duke Integrative Medicine/Duke University Medical Center Answering the Need 17 • Creation of a non-profit to develop a national standard of coaching competencies, training and education, and credentialing of professional health and wellness coaches • 75 organizations in healthcare, academia, industry and professional disciplines • Completed Job Task Analysis last month; preparing for validation survey now

20. Simmons & Wolever (2013). Integrative Health Coaching and Motivational Interviewing: Synergistic Approaches to Behavior Change in Health Care. GAHM, 2(4), 24-31.

Prevention 2014: Health Coaching to Motivate Lifestyle Change

Duke Heart

Prevention 2014: Health Coaching to Motivate Lifestyle Change