Abstract 254: The Benefits and Barriers to Remote Health Coaching in Patients at Risk for Cardiovascular Disease


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Abstract

Background: Partners’ Center for Population Health is reviewing the effectiveness of an app-based remote health coaching program, designed to complement the care of providers. The program allows patients to regularly communicate with a live health coach via text, phone, or video conferencing. The health coaches are provided by an outside vendor and are trained to provide guidance relevant to a number of chronic diseases, including obesity, hypertension and diabetes.Objectives: The aim for the health coaching cardiovascular program is to see an improvement in clinical outcomes including blood pressure, blood glucose, body mass index (BMI), and LDL cholesterol in patients at risk for cardiovascular disease. In addition, patient satisfaction and patient engagement are being evaluated.Methods: Patients must be 18 or older but less than 76 years old, and have a smartphone or tablet. Patients must also have one of the following medical conditions: (1) obesity with BMI> 30, (2) diabetes with HgbA1C >8.0%, (3) hypertension on two or more antihypertensive medications (ACEI, ARB, calcium channel blocker, beta blocker, hydrochlorothiazide, chlorthalidone, amlodipine, clonidine, or doxazosin) with a blood pressure greater than 140/90 mm Hg.Findings: Of 116 patients who have been sent a consent form to sign, 35 have completed the program and 17 are still active. All patients are from Brigham and Women’s Hospital, an academic medical center within the Partners HealthCare network. Among those who completed the program, patient engagement with the health coach varied significantly. Four patients had no consults and 13 patients had six or fewer consults with their health coach. Six patients had 20 or more consults, with the most being 41 consults.The number of messages sent between the patient and their health coach varied as well. For example, 11 patients sent less than 50 messages to their coach while four patients had each sent and/or received more than 2,000 messages. Self-reported weight loss results related to health coaching have been encouraging. Of 27 patients who recorded their weight loss 4 months or more into the pilot, 52% had lost weight. Improvements in blood pressure, blood glucose, and LDL will be measured and provided as part of the presentation. In addition to the weight loss data, 90% of the 19 patients who responded to a post health coaching survey responded that they are very motivated to improve their overall health. Challenges One of the biggest challenges has been patient enrollment. The barriers to patient enrollment have included: limited or no access to a smartphone or tablet which is required to download and use the app; resource requirements to educate patients about the program and assist them in enrollment; and a multi-step process between enrollment and the initial health coach visit. The presentation will focus on those challenges and efforts being made to overcome them.

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