The use of lay health coaching may offer a scalable model for the improvement of treatment adherence and, therefore, the care of individuals with chronic obstructive pulmonary disease (COPD), according to results published in the Annals of Family Medicine.
A multisite, single-blinded, randomized controlled trial (Aides in Respiration Health Coaching for COPD [AIR]; ClinicalTrials.gov Identifier: NCT02234284) was conducted among English- and Spanish-speaking patients with moderate to severe COPD who were recruited from urban, primary care clinics that served a low-income, largely African American population.
Recognizing that poor medication adherence is prevalent among patients with COPD and thus is linked to unfavorable health outcomes, investigators sought to examine the efficacy of lay health coaches for the improvement of inhaler adherence and technique. All of the participants, who were aged ≥40 years, were reachable by telephone and planned to continue to receive care at 1 of 7 study sites. Eligibility included the presence of moderate to severe COPD, which was confirmed by a postbronchodilator spirometry ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of <0.70 or by a pulmonologist’s review.
Both of the health coaches in the current study had obtained a bachelor’s degree from a
4-year college, but neither was a healthcare professional. The participants were randomly assigned to receive 9 months of health coaching or usual care. Study outcome measures included self-reported adherence to inhaled controller medications in the previous 7 days and observed technique for all inhalers. Among 282 individuals who were eligible for the study, 192 were enrolled, with 100 randomly assigned to receive health coaching and 92 to receive usual care.
Results of the AIR study showed that baseline adherence and inhaler technique were consistently poor and did not differ according to study group. At 9 months, patients in the health-coached group reported a greater number of days of adherence compared with those in the usual care group (6.4 days vs 5.5 days, respectively; adjusted P =.02). Moreover, health-coached patients were more likely than usual care patients to have used their controller inhaler as prescribed for 5 of the past 7 days (90% vs 69%, respectively; adjusted P =.008). Patients in the health-coached group were 3 times as likely as those in the usual care group to demonstrate perfect technique for all inhaler devices (24% vs 7%, respectively; adjusted P =.01) and mastery of essential steps (40% vs 11%, respectively; adjusted P <.001).
The investigators concluded that the use of unlicensed, trained health coaching may offer a scalable model that can help to improve the treatment of individuals with COPD.
Willard-Grace R, Chirinos C, Wolf J, et al. Lay health coaching to increase appropriate inhaler use in COPD: a randomized controlled trial. Ann Fam Med. 2020;18(1):5-14.