Pharmacists have made great strides in public health by becoming more engaged in disease management programs. Recent data has demonstrated benefits of pharmacist-led protocols for chronic disease state management. For better outcomes in disease management, adding a health coach can add value to the program. Health coaching is based on evidence-based clinical interventions such as motivational interviewing to facilitate behavior change, using concepts such as the Transtheoretical Model of change, goal-setting, and active listening. Health coaching has also been shown to improve patient outcomes and reduce healthcare costs. The collaboration of a health coach and pharmacist partnership is a relatively new concept, but initial evidence is promising.

This approach was studied at a rural free clinic over the course of one year.¹ The study utilized a pharmacist-provider collaborative practice agreement to provide disease management and health coaching services for patients with chronic diseases such as diabetes mellitus, hypertension, and hyperlipidemia. Physicians referred patients for management by the pharmacist + health coach team, who then provided chronic disease management services based on a protocol. In-depth medication and disease state education was provided at each visit by the pharmacist, and the health coach provided nutritional and lifestyle modification education through motivational interviewing. The pharmacist and health coach scheduled monthly visits with the participants that featured goal-setting and encouragement. Baseline clinical metrics were collected and analyzed every 3 months after program initiation, including hemoglobin A1c, blood pressure, and lipids. Utilizing the established protocol, the pharmacist requested laboratory tests, which were provided by the affiliated healthcare system. This approach showed statistically significant improvements in A1c, blood pressure, total cholesterol, and LDL cholesterol. Patients experienced improvement in blood pressure within 3 months, and in A1c values within 6 months after program initiation.  

When implementing a program such as this, it is critical to obtain a collaborative practice agreement (CPA) with a medical provider. This allows the pharmacist to initiate, adjust, or discontinue medications without physician consultation for the patients referred. Generally, a CPA includes policies and procedures, protocols, and pharmacist/prescriber responsibilities. A decision tree can also be included to help guide pharmacists through the patient’s clinical situation.

Pharmacy managers looking to start a new service must consider at least 3 P’s: patient, other healthcare providers, and payers. Begin by evaluating the market and determining if the new service will satisfy consumer needs. In addition to patient needs, it must be determined whether the new service will benefit, engage, and receive buy-in from other healthcare providers and from payers. Health coaching opportunities should be on the pharmacy manager’s radar. Often times, innovative services and collaborations like these originate in places like free clinics or federally qualified health centers (FQHCs), then make their way into other community settings. Health coaching is commensurate with the direction in which patient-centric health care is moving and is ripe for collaboration, thus furthering the profession’s stature in interdisciplinary care.

Additional information about Managing Value-Added Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

References:

Hurst H, Dunn S, Fuji K, Gilmore J, Wilt S, Webster S, Parikh P. Clinical impact of a pharmacist + health coach chronic disease management program in a rural free clinic. J Am Pharm Assoc. 2021; doi:https://doi.org/10.1016/j.japh.2021.02.014.

Authored by:

Lyubov Villanueva, PharmD Candidate, Touro University California, College of Pharmacy.

Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social/Behavioral Pharmacy at Touro University California.