title: What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial.
abstract: Health coaching is effective for chronic disease self-management in the primary care safety-net setting, but little is known about the persistence of its benefits. We conducted an observational study evaluating the maintenance of improved cardiovascular risk factors following a health coaching intervention.
  
  
  
  We performed a naturalistic follow-up to the Health Coaching in Primary Care Study, a 12-month randomized controlled trial (RCT) comparing health coaching to usual care for patients with uncontrolled diabetes, hypertension, or hyperlipidemia. Participants were followed up 24 months from RCT baseline. The primary outcome was the proportion at goal for at least 1 measure (hemoglobin A1c, systolic blood pressure, or LDL cholesterol) that had been above goal at enrollment; secondary outcomes included each individual clinical goal. Chi-square tests and paired t-tests compared dichotomous and continuous measures.
  
  
  
  290 of 441 participants (65.8%) participated at both 12 and 24 months. The proportion of patients in the coaching arm of the RCT who achieved the primary outcome dropped only slightly from 47.1% at 12 to 45.9% at 24 months (P = .80). The proportion at goal for hemoglobin A1c dropped from 53.4% to 36.2% (P = .03). All other clinical metrics had small, nonsignificant changes between 12 and 24 months.
  
  
  
  Results support the conclusion that most improved clinical outcomes persisted 1 year after the completion of the health coaching intervention.
authors.affiliation: Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California Anjana.sharma@ucsf.edu.
authors.forename: Anjana E
authors.initials: AE
authors.lastname: Sharma
authors.affiliation: Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California.
authors.forename: Rachel
authors.initials: R
authors.lastname: Willard-Grace
authors.affiliation: Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.affiliation: Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer
authors.affiliation: Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California.
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001794:Blood Pressure; D002140:California; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D037001:Directive Counseling / Q000379:methods; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006949:Hyperlipidemias / Q000628:therapy; D006973:Hypertension / Q000628:therapy; D016015:Logistic Models; D012307:Risk Factors; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome; D016032:Randomized Controlled Trials as Topic
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: chronic care; disease prevention; health behavior change; health promotion; minority health; patient self-care support; patient-centered care; practice-based research; primary care; special population; underserved patients