Issue 5 / 16 February 2015

A CENTRALISED health coaching program based in Queensland could improve health literacy and outcomes for rural patients, according to a leading rural health advocate.

Associate Professor Lucie Walters, president of the Australian College of Rural and Remote Medicine, described the program’s potential as “fantastic”.

A population-based audit of the COACH (Coaching Patients on Achieving Cardiovascular Health) program, published in the MJA, found it was successful in curbing cardiovascular risk factors among patients with coronary heart disease and diabetes living across Queensland. (1)

The audit, which included 1962 patients with coronary heart disease (CHD) and 707 patients with type 2 diabetes who completed the COACH program in a 5-year period, found statistically significant improvements in all biomedical and lifestyle risk factors.

The program, introduced by Queensland Health in 2009, uses registered nurses to deliver patient-specific health coaching via telephone, followed up with a mail-out summarising the agreed plan of action. Patients received an average of five coaching sessions over 6 months.

Professor Walters told MJA InSight that the program provided “an opportunity for patients to access support, without the implications of travel, and that significantly impacts rural people’s capacity to access health services”.

She said such a program could also help to ease the burden for GPs practising in areas of workforce shortage, enabling them to share this load with a multidisciplinary health team.

While a national rollout of the program would be welcome, it was important to properly resource GPs to engage with coaching teams and review patient outcomes, Professor Walters said.

Professor Garry Jennings, director and CEO of Baker IDI Heart and Diabetes Institute, said Queensland Health’s implementation of the COACH program had proved particularly beneficial in its ability to reach rural and remote patients.

He said although the study did not include a control group and the lifestyle data were self-reported, the results were impressive.

The audit found improvements in serum lipids, blood glucose, smoking habits, alcohol consumption and physical activity in patients with either disease. CHD patients increased their weekly physical activity from a mean of 142 minutes a week to 229 minutes a week, while patients with diabetes boosted their activity from 127 minutes to 181 minutes a week.

Professor Jennings said a heart attack “really shakes people up” and this was the time they were most likely to make lifestyle changes. He said this would be discussed with patients in hospital, but a coaching program reinforced this message over time and and gave patients practical and individual strategies to make these changes.

“You have to go further than just saying ‘get more exercise’; you have to talk to people about what they like, what they are capable of doing, what facilities are available.”

The Heart Foundation’s Queensland health director Rachelle Foreman said the flexibility offered with a program such as COACH was an essential part of the health management mix for urban as well as rural and remote patients.

“It’s not just about access, it’s also about patient preference and what fits with their lifestyle and learning style”, she said, noting that about half of the patients in the MJA audit lived in the city.

Despite the evidence of benefit, the COACH program and traditional rehabilitation services were still underutilised in Queensland, which recorded 33 000 acute coronary syndrome admissions annually, Ms Foreman said.

Although the program audit included only 145 Indigenous Australians, the researchers found no significant differences in risk factor changes between Indigenous and non-Indigenous populations.

This finding came as an MJA editorial highlighted “striking” disparities in heart failure incidence between Aboriginal and non-Aboriginal Australians. The authors called for urgent attention to the prevention and management of heart failure in Aboriginal patients and outlined strategies to achieve this. (2)

Professor Jennings said heart failure did not come out of nowhere. “Heart failure comes from extraordinarily high rates of high blood pressure, as well as diabetes and other well known predisposing factors. If [these risk factors] can be properly identified and be managed, we can prevent these heart failure rates.”

He said a program such as COACH could be helpful in reducing Indigenous disadvantage, but it would need to be more specific to the Indigenous context.

“There does need to be an overlay of more than cultural sensitivity; cultural appropriateness is [also] needed. It has to be the right people giving advice both in a manner and language that will be understood”, he said.

 

1. MJA 2015; 202: 148-152
2. MJA 2015; 202: 116-117

(Photo: nyul / iStock)

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