Health Coaching Dramatically Lowers Patients’ Systolic Blood Pressure

(AAFP.org) — Give low-income patients with hypertension access to the services of a trained health coach, ensure that the coaching includes frequent phone contact, and watch systolic blood pressure levels plummet by an average of 22 mm Hg. That’s the result reported recently by family medicine researchers in the University of California-San Francisco’s (UCSF’s) Department of Family and Community Medicine. Their findings were highlighted in “Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population” (7-page PDF; About PDFs), an article in the May/June issue of Annals of Family Medicine.

Corresponding author Thomas Bodenheimer, M.D., is the
co-director of the Center for Excellence in Primary Care at the UCSF School of Medicine. As such, he is no stranger to the topic of health coaching and patient self-management. Bodenheimer’s work on the subject includes a series of videos created for the California Healthcare Foundation.

But Bodenheimer told AAFP News Now that his past experience didn’t prepare him for the positive results that were revealed at the conclusion of this study. “I was surprised by how much the blood pressures went down because most studies about trying different ways to improve hypertension will get a 5 or 6 millimeter drop in blood pressures — we got a 22 millimeter (average) drop in blood pressure,” said Bodenheimer.

“That’s an enormous drop. I thought the coaches could really help, but I didn’t think they could help that much,” he added.

According to study authors, about 50 percent of U.S. patients with hypertension have poorly controlled blood pressure. Part of the problem, noted researchers, is that patients typically want multiple health concerns addressed in an all-too-short 15-minute office visit. “They often leave the visit without knowing their blood pressure level or goal,” said the authors.

In addition, physicians — typically primary care physicians, because their offices account for nearly 80 percent of patient visits for elevated blood pressure — have so many competing demands on their time that they may not always be able to address a patient’s hypertension.

Bodenheimer said the study’s most important findings get at the heart of how to solve those issues. First, “You can actually affect blood pressure in a very profound way without involving physician time by training coaches in how to effect behavioral change in patients,” he said.

Secondly, study results indicate more coaching is better. “The more telephone calls between a coach and a patient, the better the patient’s blood pressure. It’s almost like a medicine; if you increase the dose of coaching, you get a better result,” said Bodenheimer.

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