title: The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial.
abstract: BACKGROUND
  Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence.
  
  
  METHODS
  This was a nonblinded, randomized, controlled, pragmatic intervention trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled from 2 urban safety net clinics and randomized to receive 12 months of health coaching versus usual care.
  
  
  RESULTS
  Outcomes included concordance between medications documented in the medical record and those reported by the patient and adherence based on the patient-reported number of days (of the last 7) on which patient took all prescribed medications. The proportion of medications completely concordant increased in the coached group versus the usual care group (difference in change, 10%; P = .05). The proportion of medications listed in the chart but not taken significantly decreased in the coached group compared with the usual care group (difference in change, 17%; P = .013). The mean number of adherent days increased in the coached but not in the usual care group (difference in change, 1.08; P < .001).
  
  
  CONCLUSIONS
  Health coaching by medical assistants significantly increases medication concordance and adherence.
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC). dthom@fcm.ucsdf.edu.
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Rachel
authors.initials: R
authors.lastname: Willard-Grace
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Denise
authors.initials: D
authors.lastname: DeVore
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Camille
authors.initials: C
authors.lastname: Prado
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD, CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
authors.forename: Ellen
authors.initials: E
authors.lastname: Chen
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D003920:Diabetes Mellitus / Q000188:drug therapy*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged
keywords: Health Behavior; Medication Adherence; Self Care