It’s an intriguing idea: Coach people into being more effective patients who can ask doctors better questions and seek clarification about medication and the cost of treatments when needed.
That’s the goal of a study by Professor Sherrie Kaplan of the UC Irvine School of Medicine, who recently concluded a research project on the effectiveness of diabetes coaches.
The study paired diabetes coaches with 300 Orange County patients to help them prepare for more productive doctor visits. Results of the research so far are promising, said Kaplan, who found that some patients made significant improvements in their health as a result of the coaching with the biggest gains among Mexican-American patients.
Kaplan, who is also an assistant vice chancellor at UCI and executive co-director of the university's Health Policy Research Institute, spoke recently with Voice of OC.
Q: What is a diabetes coach?
A: We’ve found people who themselves have diabetes and who come from the same socioeconomic and ethnic racial background as the patients being seen, in this case, at UC Irvine’s outpatient clinics. We teach these patients to coach others in how to ask question of doctors, how to participate more effectively in treatment decisions, how to negotiate treatments that match their life circumstances, such as how to ask, “If I can’t afford this medicine, do I have other options?” Those coaches are not designed to teach people about diabetes; they are there to teach people how to be a more effective patient.
Q: Can you say more about the study?
A: It’s just now wrapping up. What we’ve done is conduct a randomized control trial at UCI’s six ambulatory clinics. What these coaches do is in the roughly 20 minutes before patients see doctors. They go over a patient’s last visit and what to expect on their upcoming visit; whether they have questions; how to sharpen those questions; how they’re going to ask the doctor questions; if they have any problems implementing treatment regimens and how to raise them with doctors. It’s not always easy to ask questions of doctors. People can get somewhat intimidated. … We train coaches not to give medical advice, and we audiotape their training sessions.
Q: What else do the coaches do?
A: Then the patient goes in to see doctor and the coach gets a debriefing on how it went and follows up between visits with monthly phone calls. They ask how it’s going and if there are any issues. They tell patients to be sure and write them down. That goes on for a one-year period. We’ve looked at the impact of this kind of coaching and compared it with standard diabetes education materials, the state-of-the-art patient education materials that would be used by American Diabetes Association, such as those on the ADA website.
Q: What are some results in particular?
A: What we’ve found is — and these are largely patients with lower socioeconomic status — that on average there’s a 0.4 to half percent lowering of blood glucose. That’s pretty good. We managed to lower the blood glucose by about half a percent. It’s both statistically significant and clinically meaningful.
Q: Why are diabetes coaches needed?
A: The average patient in a diabetes visit asks four questions. That includes, “Can you validate my parking?” The most common number of questions asked by men during the visit is zero. We have as a society taught people to be passive as patients.
We go in, we show up, and we shut up. We don’t tend to ask questions in a very direct way. When you ask people if doctors brought them into treatment decisions — discussions about pros and cons — and ask about patient preferences, this happens about in 15 percent in doctor patient-conversations. We have a long way to go to get patients involved in treatment decisions.
We think we’ve become more assertive and a more consumer-oriented society, but we’re not getting that much better at being actively involved patients. For people who do library research, the Web has put information at people’s fingertips. There’s information out there, but we tend not to know how to use it.
Q: Why is coaching so helpful when it comes to diabetes as opposed to other illnesses?
A: Managing diabetes is a complex process. As we age we tend to get things along with diabetes, such as heart disease, that also have to be managed. Control is not stable, and people have to make decisions about what new treatments to bring in. It’s a changing process. Also, diabetes has a big lifestyle component. … Doctors aren’t trained to ask, “Can you afford this medication?” or “What are the barriers to getting exercise?”
Q: Can you give an example of something a coach can help a patient do better in dealing with a doctor?
A: Some patients don’t know what lipid levels are or what blood pressure it. Coaches say, “You need to know about that. How about you ask the doctor, ‘What was my last hemoglobin A1C value?’ ”
We’ve heard from physicians that they were shocked someone wanted to know that. That signals interest by the patient, and the doctor comes back with more information and is more likely to probe and ask a little more. “Is there anything else you want to know?” It jumps a level you don’t often see in standard doctor-patient dialogue.
Q: What lessons can you draw from this study?
A: We think there are implications. With health care costing what it does, you’d think there would be more preparation to be a patient. The lifetime probability of being a patient is 100 percent. We think this should be part of a national strategy to determine how you choose doctors and health plans, how to ask about how much things cost, when you should negotiate for treatment options. We think this should be part of a national policy shift.
Amy DePaul is a Voice of OC contributing writer and lecturer in the UC Irvine literary journalism program. You can reach her directly at firstname.lastname@example.org