title: Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?
abstract: OBJECTIVE
  Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care.
  
  
  METHODS
  A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs.
  
  
  RESULTS
  A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, P<0.0001). Coaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, P<0.0001).
  
  
  CONCLUSIONS
  A correctible and even preventable contributing component in diabetes care corresponds to physicians' performance. After 3 years of implementation, coaching was found to be worth the effort to improve type 2 diabetes control in primary care.
authors.affiliation: Internal Medicine Specialist, Health Planning Coordinator of the Medical Services Division, Mexican Institute of Social Security, Monterrey, Mexico.
authors.forename: Eduardo Enrique
authors.initials: EE
authors.lastname: González-Guajardo
authors.affiliation: Primary Care Specialist, Epidemiologic and Health Services Research Unit, Mexican Institute of Social Security, Monterrey, Mexico. Electronic address: amsalinasm@intercable.net.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Salinas-Martínez
authors.affiliation: Primary Care Specialist, Medical Director of the Family Medicine Clinic No. 5, Mexican Institute of Social Security, Monterrey, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Botello-García
authors.affiliation: Primary Care Specialist, Epidemiologic and Health Services Research Unit, Mexican Institute of Social Security, Monterrey, Mexico.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Mathiew-Quiros
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D000071252:Mentoring / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010821:Physicians, Family / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Coaching; Effectiveness; Family medicine; Primary care; Type 2 diabetes