Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results from a Pragmatic, Cluster-Randomized Controlled Trial
Objective. This cluster (clinic-level) randomized controlled trial compared medical assistant health coaching (MAC) to usual care (UC) among at-risk adults with type 2 diabetes in two diverse, real-world primary care environments: A Federally Qualified Health Center (FQHC; Neighborhood Healthcare) and a large, non-profit, private insurance-based health system (Scripps Health). Research Design and Methods. N=600 adults with type 2 diabetes and ≥1 of the following in the last 90 days were enrolled: HbA1c ≥8% and/or low-density lipoprotein cholesterol (LDL-C) ≥100mg/dL and/or systolic blood pressure (SBP) ≥140mm/Hg. Participants at MAC clinics received in-person and telephone self-management support from a specially trained MA health coach for 12 months. Electronic medical records were used to examine clinical outcomes in the overall sample. Behavioral and psychosocial outcomes were evaluated in a subsample (n=300). Results. All clinical outcomes improved significantly over one year in the overall sample (ps<.001). The reduction in HbA1c was significantly greater in the MAC vs. UC group (unstandardized Bint=-0.06, p=.002). A significant time by group by site interaction showed MAC to also achieve greater improvements in LDL-C than UC at Neighborhood Healthcare relative to Scripps Health (Bint=-1.78 vs. 1.49, ps<.05). No other statistically significant effects were observed. Conclusions. This was the first large-scale, pragmatic trial supporting the real-world effectiveness of MA health coaching for type 2 diabetes in US primary care settings. Findings suggest that this team-based approach may be particularly effective in improving diabetes outcomes in FQHC settings.
