Improving Vascular Health: Health Coaching with Motivational Interviewing
Summer months are always the hardest for lupus patients. For me, suffering from a severe flare up after returning from conference November 2017; I started a journey of getting into optimal health. I did an extensive literature search and the information was so limited that I was more confused than liberated. To take power over my health and not let my body defeat me, I started making vast changes. There was several studies that suggested loading up on proper nutrients prior to a flare up to strengthen the immune system prior to a stressful event. Other studies focused on staying active and incorporating exercise such as yoga and tai chi for muscle strength and flexibility. What does this have to do with CVD? I am glad you asked. Lupus is a chronic inflammatory disease, as is CVD. There are various forms such as lupus nephritis, systemic lupus erythematosus, mesenteric vasculitis, and others. These forms of lupus affect the vascular system in a similar manner as CVD and generally people with these diagnosis have hypertension. For me, I have started a journey that started from learning from other early career bloggers in addition to my own research, but for the general population health coaching may be a viable option.
Note: This post will be a part of a series of health coaching (1 of 4).
As serendipity will have it, I met a summer student while I was having lunch in the common break room (which I never do because who has time for lunch?). This student was studying Motivational Interviews (MI) under the direction of James Bailey, MD, MPH from the University of Tennessee Health Science Center (UTHSC). I had often run into Dr. Bailey and had insightful conversations about health, insurance and UTHSC life in general. Speaking with this student piqued my curiosity about how health coaching can help patients improve vascular health. Thus, I scheduled a formal meeting with Dr. Bailey to discuss in more detail the role MI plays in reducing cardiovascular symptoms such as hypertension and subsequently boosting the immune response. The interview went as follows:
Q1. Why health coaching? Is it feasible, sustainable, and who will pay for the service?
A. Motivational interviews are patient centered communications that is used to encourage change and adherence to medical therapy.
B. We (physicians) are looking for the lowest cost evidence-based approaches that will help personnel and it was found that health coaches were most cost efficient. In this model lower level medical staff can do it with fidelity and be trained to conduct the interviews.
Note: There was a 2017 study in which a cohort of doctors used “Task-shifting” strategies as a means of improving patient compliance to medical treatment. In this model, there was a rational movement of primary care duties passed from physician to ‘lower medical staff’ or non-physician health care workers such as nurses or pharmacy residents to determine optimal management of disease. This study demonstrated two noteworthy findings: (1) there were disconnects in perspectives of disease states. The physician believes hypertension is a biomedical model which should be seen as a chronic life-long illness; whereas the patient sees it as a disease of nervousness in which the blood pressure can be reduced with reduced stress. (2) The way in which the intervention is perceived and the relationship with the provider impacted the degree of compliance to intervention.
Training for MI can be conducted over a 3-day period: 2 days training include lecture, discussion, demonstration, videos, and observed role playing of MI skills. Day 3 consist of simulated trainings with patients. Trainers are evaluated using the 7-point Likert-type scale for MI skills and spirit (expressing empathy, using reflective listening, and language to promote behavioral change).
C. MI is based on identifying and helping patients set their own goals. It is more effective than diabetes, hypertension, (and lupus) training. The interviewing help identify barriers/promoters in the patient’s life that can assist in improving adherence. Promoters such as: one patient said, “the nurse was convincing and her personal relationship drove me to attend’ or ‘the nurse gave me details and explanations from other patients in the program’. Barriers can include: ‘money for buying healthy food is difficult although some can be naturally grown, most have to be purchased’; ‘not all healthy food is available in my immediate surroundings so it is necessary to travel a few miles to buy them and I haven’t a car or money for a bus’; and ‘I always feel a bit tired after work and my family has been troublesome.’
Thinking of MI as a gym coach, there is a relationship of accountability that generates trust. This model only works if there is a level of communication and responsiveness because the patient is taking the lead in improving their life. The coach is there for support.
D. This model works better being a part of primary care rather than a part of insurance. High value care, care at low cost gives great care. A single ER visit can be $2,000 to $4,000, so to avoid at least one hospital visit with MI can reduce cost. Health care strengthen lifestyle changes and coaches are high value options.
Note: Previous use of this model demonstrated significant savings. In the 2011 study analyzing cost avoidance using clinical interventions there was an estimated $23,000 savings with the use of MI.
Q2. Where do we go from here to improve our health care?
A. As medical professionals are becoming more in tuned to high quality primary care they become more investing in health care to strengthen the primary care team. There is a model of value-based payment (VBP) vs pay per service (PPS). Many routine services are getting no benefit with and no return. VBP suggest we should pay a global payment to keep us well. This gives a huge incentive to keep people out of hospitals and keep them healthy. Changing the way you pay will keep people out of the hospital and keep them well. In this model it is the revisiting of the health maintenance model. This model could work through both the private and public health sectors to save on cost and improve overall patient health.
B. Health coaching can be the best tool for keeping people healthy and it cost less. We should have teams to make individual patients health better. For a health coach to work one-on-one with a patient via MI compliance will improve and physicians can see better outcomes with chronic illnesses.
Dr. Bailey is currently working on a study under the PCORI Model (Management of diabetes in everyday life) effectiveness trial of health coaching, motivational text studies, and health care. The pilot data thus far is promising suggesting a reduction in diabetes employing MI strategies.
- Nutritional coaching
- Fitness coaching
- Mental coaching
- Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.
Follow Dr. Bailey on Twitter for more on motivational interviewing @thehealthycity
Anberitha Matthews, PhD is a Postdoctoral Fellow at the University of Tennessee Health Science Center in Memphis TN. She is living a dream by researching vascular injury as it pertains to oxidative stress, volunteers with the Mississippi State University Alumni Association, serves as Chapter President and does consulting work with regard to scientific editing.