title: Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence.
abstract: OBJECTIVE
  Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. The purpose of the study is to determine whether IHC improves oral medication adherence, glycated hemoglobin (HbA1c), and psychosocial measures, and to assess whether adherence changes are sustained after the intervention.
  
  
  METHODS
  Using a prospective observational design, participants (n=56) received 14 coaching calls by telephone over 6 months. Medication possession ratio (MPR) was calculated for time intervals before, during, and after the intervention. HbA1c and patient-reported psychosocial outcomes were obtained to test interactions with MPR.
  
  
  RESULTS
  Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155 during coaching, and was sustained at 0.82±0.175 during a 6-month period after the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All psychosocial measures showed significant improvement. In addition to discussing medication adherence strategies with their coach, patients discussed nutrition and exercise (86.9% of calls), stress management (39.8%), and social support and relationships (15.4%).
  
  
  CONCLUSIONS
  IHC targets internal motivation and supports behavior change by facilitating patients' insight into their own behaviors, and it uses this insight to foster self-efficacy. This approach may yield sustainable results for medication adherence and warrants further exploration for health-related behavior change.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt Schools of Medicine & Nursing, Nashville, Tennessee, USA; Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Ruth Q
authors.initials: RQ
authors.lastname: Wolever
authors.affiliation: Duke Integrative Medicine , Duke University School of Medicine , Durham, North Carolina , USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Dreusicke
keywords: Behavioral Interventions; Psychosocial Variables; Self-Management; Type 2 Diabetes