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Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results from a Pragmatic, Cluster-Randomized Controlled Trial

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posted on 2024-05-16, 14:29 authored by Addie L. Fortmann, Emily C. Soriano, Linda C. Gallo, Taylor L. Clark, Samantha R. Spierling Bagsic, Haley Sandoval, Jennifer A. Jones, Scott Roesch, Todd Gilmer, James Schultz, Thomas Bodenheimer, Athena Philis-Tsimikas

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.

Funding

This trial was generously funded by the U.S. National Institute of Diabetes and Digestive and Kidney Disease R18DK104250 (PIs: Philis-Tsimikas/Gallo).

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