No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Coaching patients with coronary heart disease to achieve the target cholesterol
Abstract
Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease (CHD). An effective strategy is required for the application of evidence-based prevention therapy for CHD. The objective of this study was to test coaching as a technique to assist patients in achieving the target cholesterol level of
... The earliest paper that met the inclusion criteria was published in 1987, 47 with only 12 articles published before 2000. 22 Of the programs identified by this review, most were based in Queensland (n = 24) 21,22,26,31,40,43,49,53,59,61,62,[67][68][69][70][71]80,81,[85][86][87][88][89][91][92][93][97][98][99][100][101] or New South Wales (n = 21). 18,19,24,25,34,39,46,54,58,63,72,76,85 Ten of the programs were based in Western Australia, 32,33,38,40,51,52,[64][65][66]77,78,84,102 nine in the Northern Territory, 30,36,44,45,50,[55][56][57]60,68,71,73,75,[94][95][96] six in South Australia, 20,23,[27][28][29]41,42,79,85 five in Victoria 74,82,83,85,87,98,99,103 and one in Tasmania. ...
... 22 Of the programs identified by this review, most were based in Queensland (n = 24) 21,22,26,31,40,43,49,53,59,61,62,[67][68][69][70][71]80,81,[85][86][87][88][89][91][92][93][97][98][99][100][101] or New South Wales (n = 21). 18,19,24,25,34,39,46,54,58,63,72,76,85 Ten of the programs were based in Western Australia, 32,33,38,40,51,52,[64][65][66]77,78,84,102 nine in the Northern Territory, 30,36,44,45,50,[55][56][57]60,68,71,73,75,[94][95][96] six in South Australia, 20,23,[27][28][29]41,42,79,85 five in Victoria 74,82,83,85,87,98,99,103 and one in Tasmania. 35 One program did not identify the community in which it was run. ...
... 22,39,52,61,62,86,97,100,108 Programs were also delivered across multiple settings such as the community and PHC settings (n = 16), 20,23,30,34,36,44,45,51,53,56,57,59,60,[64][65][66]75,76,[91][92][93]101,104,106,111 community and school (n = 9), 32,50,55,73,79,80,85,[94][95][96]103 community, PHC and school (n = 2), 26,41,42 PHC and school (n = 1), 21 PHC and outpatients (n = 1) 58 community, PHC and physiotherapist practice (n = 1) 35 and one was delivered via telephone and postal service. 87,98,99 Thirty of the programs focused on more than one of the SNAPS risk factors. 20,[27][28][29][30][32][33][34][35][36][37][41][42][43][44][45][46][51][52][53][54][60][61][62]70,74,75,[81][82][83][84][85]87,88,98,99,101,107,109,111,112 Forty-one of the programs focused on modifying only one behavioural risk factor; of these, seven focused on smoking (see Table 1), 26,40,50,55,[63][64][65][66]89 seventeen on nutrition (see Table 2), 18,21,[23][24][25]31,49,56,57,59,76,78,100,[102][103][104][105][106]108,110 five focused solely on alcohol prevention and/or management (see Table 3), 22,47,58,73,86 four on physical activity (see Table 4) 72,80,106,110 and eight on social and emotional wellbeing (see Table 5). ...
Issue addressed:
Non-communicable chronic disease underlies much of the life expectancy gap experienced by Aboriginal and Torres Strait Islander people. Modifying contributing risk factors; tobacco smoking, nutrition, alcohol consumption, physical activity, social and emotional wellbeing (SNAPS) could help close this disease gap. This scoping review identified and describes SNAPS health promotion programs implemented for Aboriginal and Torres Strait Islander people in Australia.
Methods:
Databases PubMed, CINAHL, Informit (Health Collection and Indigenous Peoples Collection), Scopus, Trove, and relevant websites and clearing houses were searched for eligible studies until June 2015. To meet the inclusion criteria the program had to focus on modifying one of the SNAPS risk factors and the majority of participants had to identify as being of Aboriginal and/or Torres Strait Islander heritage.
Results:
The review identified 71 health promotion programs, described in 83 publications. Programs were implemented across a range of health and community settings and included all Australian states and territories, from major cities to remote communities. The SNAPS factor addressed most commonly was nutrition. Some programs included the whole community, or had multiple key audiences, whilst others focused solely on one sub-group of the population such as chronic disease patients, pregnant women, or youth. Fourteen of the programs reported no outcome assessments.
Conclusions:
Health promotion programs for Aboriginal and Torres Strait Islander people have not been adequately evaluated. The majority of programs focused on the development of individual skills and changing personal behaviours without addressing the other health promotion action areas, such as creating supportive environments or re-orienting health care services.
So what:
This scoping review provides a summary of the health promotion programs that have been delivered in Australia for Aboriginal and Torres Strait Islander people to prevent or manage chronic disease. These programs, although many are limited in quality, should be used to inform future programs. To improve evidence-based health promotion practice, health promotion initiatives need to be evaluated and the findings published publicly.
... Coaching is a up and coming intervention in pediatric rehabilitation and is frequently approached from a family-centered perspective, which involves assisting children, youth, and parents to collaboratively find solutions in partnership with the rehabilitation practitioner (RP) (Graham, Rodger, & Ziviani, 2009;Schwellnus, King, & Thompson, 2015;Vale, Jelinek, Best, & Santamaria, 2002). Being a goal-oriented means of facilitating client engagement and empowerment, coaching is distinct from more traditional impairment-focused methods of working within pediatric rehabilitation (An & Palisano, 2014;Baldwin et al., 2012Baldwin et al., , 2013. ...
Background: The ultimate goal of therapeutic intervention is meaningful participation in one’s world. For people with Cerebral Palsy (CP), limitations can often become a focus of care.
Aim: Our purpose was to investigate the impact of a Solution-Focused Coaching intervention designed for pediatric rehabilitation (SFC-peds) on the attainment of participation goals for children/youth with CP.
Method: Twelve participants participated in a repeated measures quantitative study and in qualitative interviews. Children and youth (ages 6-19) and their families participated in three to five coaching sessions, including an initial baseline goal setting session, with one additional follow-up session as well as the qualitative interviews. The Canadian Occupational Performance Measure and Goal Attainment Scaling were incorporated into initial coaching sessions and then re-administered by a blind assessor within one month post-intervention. Qualitative interviews were conducted at this time.
Results: Statistically significant improvements were found in goal performance, satisfaction, and attainment. Interview data included consideration of both the content of the intervention (what the practitioner is doing) and the unique SFC-peds process (how the client feels about the intervention).
Conclusions: SFC-peds may present an effective approach for working with children/youth with CP to achieve self-selected participation-oriented goals in a relatively short time-period.
... The past 25 years have witnessed an increase in the role of science to guide practice (Chorpita and Regan 2009;Flaspohler et al. 2012;Shlonsky et al. 2011;Tseng and Nutley 2014). Findings from multiple service sectors, including education (e.g., Rones and Hoagwood 2000;Slavin et al. 2009), social welfare (e.g., Dawson and Berry 2002;Gershater-Molko et al. 2003), health (e.g., Darmstadt et al. 2005;Vale et al. 2002), and mental health (Weisz et al. 2006;, have demonstrated consistently that some programs, interventions, or solutions are more effective than others. In the area of mental health care, this accumulation of positive findings has spurred policy that has increasingly prioritized mental health service delivery backed by evidence (e.g., Chambless and Hollon 1998;National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Invention and Deployment 2001). ...
Use of evidence to inform clinical decisions has been shown to improve the quality and effectiveness of services. This study piloted an observational coding system for understanding providers and supervisors’ use of evidence in their clinical decision-making. The Action Cycle and Use of Evidence Behavioral Observation Coding System (ACE-BOCS) is based on Graham et al. (Contin Educ Health Prof 26:13–24, 2006) conceptual framework for knowledge management, which articulates a sequence relevant to integrating evidence into decisions and actions, including identifying and selecting a problem and choosing, planning, and rehearsing a solution or action. Using the ACE-BOCS, two coders rated the extensiveness with which evidence was used to inform decisions made in clinical supervision sessions. In these clinical supervision sessions, supervisor-provider dyads discussed cases (N = 30; age range 8–19 years; 80% Latino/a or Hispanic ethnicity) that were identified as potentially being at risk for low treatment engagement in school mental health services. Results indicated that the ACE-BOCS can reliably and validly measure use of evidence and distinguish between strategic and indiscriminate use of evidence. The ACE-BOCS has value and utility for studying use of evidence, as it incorporates multiple actions related to service delivery and has the potential to be adapted for other aspects of mental healthcare decision-making beyond clinical supervision, as well as decision making within fields outside of mental health.
... While career issues may enter into health and wellness coaching, the primary foci of these kinds of coaching are symptom management and regimen compliance. Examples are achieving target cholesterol levels (Vale, Jelinek, Best, & Santamaria, 2002), coping with low back pain Angel, Jensen, Gonge, Maribo, Schiøttz-Christensen and Buus (2012) and learning Tai Chi to manage the stresses of illness (Galantino, Shepard, Krafft, Lapierre, Ducette, Sorbello., Barnich, Condoluci and Farrarr, 2005). ...
Chronic illness is a growing issue in the workplace, and can prompt employees to reconsider their professional and personal goals due to potential future physical limitations. Coaching can provide support to keep employees in the workforce. In this study, 34 employed people with chronic illnesses participated in a chronic illness career coaching intervention to help develop personal resources to stay in the workforce. Our analysis of data from exit interviews suggests that coaching supports coachees’ identity work and behavioral strategies for integrating illness and work, increasing their confidence and improving their expectations for continuing to work.
Context
Primary care practice.
Objective
To test whether the principles of complex adaptive systems are applicable to implementation of team-based primary care.
Design
We used complex adaptive system principles to implement team-based care in a private, five-clinic primary care practice. We compared randomly selected samples of patients with coronary heart disease (CHD) and diabetes before system implementation (March 1, 2009, to February 28, 2010) and after system implementation (December 1, 2011, to March 31, 2013).
Main Outcome Measures
Rates of patients meeting the composite goals for CHD (blood pressure < 140/90 mmHg, low-density lipoprotein cholesterol level < 100 mg/dL, tobacco-free, and using aspirin unless contraindicated) and diabetes (CHD goal plus hemoglobin A1c concentration < 8%) before and after the intervention. We also measured provider and patient satisfaction with preventive services.
Results
The proportion of patients with CHD who met the composite goal increased from 40.3% to 59.9% (p < 0.0001) because documented aspirin use increased (65.2%–97.5%, p < 0.0001) and attainment of the cholesterol goal increased (77.0%–83.9%, p = 0.0041). The proportion of diabetic patients meeting the composite goal rose from 24.5% to 45.4% (p < 0.0001) because aspirin use increased (58.6%–97.6%, p < 0.0001). Increased percentages of patients meeting the CHD and diabetes composite goals were not significantly different (p = 0.2319). Provider satisfaction with preventive services delivery increased significantly (p = 0.0017). Patient satisfaction improved but not significantly.
Conclusion
Principles of complex adaptive systems can be used to implement team-based care systems for patients with CHD and possibly diabetic patients.
The purpose of this article is twofold: (1) to announce the findings of the job task analysis as well as national training and education standards for health and wellness coaching (HWC) that have been developed by the large-scale, collaborative efforts of the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) and (2) to invite commentary from the public. The rapid proliferation of individuals and organizations using the terms of health and/or wellness coaches and the propagation of private industry and academic coach training and education programs endeavoring to prepare these coaches has created an urgent and pressing need for national standards for use of the term health and wellness coach, as well as minimal requirements for training, education, and certification. Professionalizing the field with national standards brings a clear and consistent definition of health and wellness coaching and accepted practice standards that are uniform across the field. In addition, clear standards allow for uniform curricular criteria to ensure a minimal benchmark for education, training, and skills and knowledge evaluation of professional health and wellness coaches.
Objective:
A proactive, multifactorial intervention strategy incorporating single-pill amlodipine/atorvastatin (SPAA) (5-10/10 mg up-titrated to 5-10/20 mg, where approved) is more effective than physician's usual care (UC) for reducing calculated 10 year coronary heart disease (CHD) risk, in patients with hypertension and additional risk factors (CRUCIAL trial: Curr Med Res Opin 2011;27:821--33). As SPAA combinations containing atorvastatin 20 mg are not approved in some countries, this post hoc analysis investigated the efficacy and safety of a proactive intervention strategy incorporating low-dose SPAA (5/10 or 10/10 mg) only (low-dose PI) versus UC.
Methods:
Of 1461 CRUCIAL participants (35-79 years; hypertension and ≥3 additional risk factors; no CHD; total cholesterol ≤6.5 mmol/L), 105 were prescribed SPAA containing 20 mg atorvastatin and excluded. The primary endpoint was difference between treatment arms in Framingham 10 year CHD risk after 52 weeks; secondary assessments included difference in calculated CHD risk at Week 16; SCORE cardiovascular mortality (Week 16 and 52); blood pressure (BP)/lipid parameters; adverse events (AEs).
Results:
Baseline BP (149.2/89.2 vs. 144.3/86.5 mmHg) and calculated CHD risk (19.6% vs. 18.1%) were higher for low-dose PI (n = 655) versus UC (n = 657) patients. Least-squares mean treatment difference (low-dose PI vs. UC) in calculated 10 year CHD risk was -26.8 (95% CI: -31.7, -22.0; p < 0.001) after 52 weeks' follow-up and -24.8 (-29.8, -19.9; p < 0.001) after 16 weeks' follow-up. Treatment difference in SCORE mortality was -20.1 (-24.7, -15.6; p < 0.001) and -22.4 (-26.8, -18.0; p < 0.001) after 16 and 52 weeks' follow-up. Risk calculations are surrogate endpoints and may not translate into actual reductions in cardiovascular events. Overall, 49.1% (low-dose PI) and 44.0% (UC) reported AEs.
Conclusion:
A proactive, multifactorial approach to cardiovascular management based on low-dose SPAA led to statistically significant improvements in calculated 10 year CHD risk versus physician's UC, comparable to that reported in the full CRUCIAL trial. These data will inform healthcare providers in countries where SPAA (5/10 or 10/10 mg) only are licensed.
HOWARD LM, CECI C. Nursing Inquiry 2012 [Epub ahead of print] Problematizing health coaching for chronic illness self-management To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self-management or self-care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self-management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self-management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the 'care' of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self-management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.
Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change) for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting.
Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health (intervention cohort) and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD) to create a pool of 21,052 controls (control cohort). Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/- 30 days limits) and within +/- 90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels.
After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95% CI 0.1, 0.4%) in HbA1c; 3.5 mmHg (1.5, 5.5) in systolic blood pressure, 1.6 mmHg (0.4, 2.7) in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0) in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2)). More marked effects were seen for each clinical outcome among patients with worse baseline levels.
Despite the limitations of the study design, the results are consistent with the Birmingham Own Health telephone care management intervention being effective in reducing HbA1c levels, blood pressure and BMI in people with diabetes, to a degree comparable with randomised controlled trials of similar interventions and clinically important. The effects appear to be greater in patients with poorer baseline levels and the intervention is effective in the most deprived populations.
Patient education post-coronary artery bypass graft (CABG) surgery is an essential component of nursing care aimed at assisting patients in caring for themselves at home, following discharge from hospital. While there has been a recent interest in conducting meta-analysis and systematic reviews on the effectiveness of patient education during the preoperative period, no review was found on the topic of postoperative CABG patient education. This systematic review addressed the clinically-relevant questions: what approach, mode, and dose is most effective in producing changes in CABG patient education? Studies were included in the systematic review if they met the following selection criteria: (1) the sample represented adult (> or =18 years) patients who underwent CABG surgery; (2) the educational intervention involved the provision of self-care information following surgery but before discharge from hospital; (3) the outcome assessed related to self-care behavior; and (4) the study report was published in English between 1986 and 2008. A descriptive synthesis was used to code and extract data on publication information, study design, sample size, and quality of study, as well as postoperative CABG teaching, self-care behavior performance, and demographic characteristics of the patients who participated in the studies. A quantitative synthesis consisted of a statistical approach, which was used to calculate the magnitude of the treatment effects on self-care behavior. Results indicated larger effect sizes for CABG patient education in which the content was individualized, and given in a combination of media on an individual basis, and in more than one session.
Erectile dysfunction (ED) is highly prevalent in men with cardiovascular disease (CVD), yet it is frequently underrecognized and underdiagnosed in clinical practice. Even among clinicians who acknowledge the relevance of addressing sexual issues in their patients, there is a general lack of awareness of the optimal approach for sexual problem identification and management. Additionally, cardiac rehabilitation programs typically neglect the role of sexual function. The trajectory of CVD and ED may necessitate continuous adjustment by both patients and their partners as they adapt to the chronicity of heart disease and the changing reality of their sexual lives. Health professionals typically approach management of these disorders from a disease-centered perspective, which often fails to incorporate the patient's needs and perspectives. In turn, patients frequently complain of a lack of sensitivity or awareness on the part of their physicians. From a patient-centered perspective, greater emphasis is placed on life satisfaction and quality of life as primary outcomes of treatment. Finally, a patient-centered framework is relevant for both treatment and prevention of cardiac risk in men with ED, in addition to ED management in patients with or without overt CVD.
ResearchGate has not been able to resolve any references for this publication.