Health Coaching for Chronic Conditions

bh IN BRIEF

More than 50% of Canadians have a chronic disease or condition. Combining direct medical costs and indirect productivity losses, the total economic burden of chronic illness exceeds $100 billion a year. Dr. Wong-Rieger is an acknowledged Canadian expert on health coaching, and discusses the opportunity to reduce the burden of chronic disease. Health coaching may benefit employees, employers and governments through reduced health care and disability costs, and better treatment adherence by patients.

Dr. Wong-Rieger has recently published a White Paper entitled "Health Coaching for Chronic Conditions. Engaging and supporting patients to Self-Manage."

Durhane Wong-Rieger, PhD, President & CEO of the Institute for Optimizing Health Outcomes, Toronto.

Dr. Wong-Rieger has a BA in psychology from Barnard College in New York City, and an MA and Ph.D in social psychology from McGill University.

Sources: (1) Canadian Coalition for Public Health in the 21st Century, 2009. (2) The Chronic Disease Prevention Alliance of Canada, 2004.

1. Chronic disease significantly contributes to high drug and disability costs for employers. How can health coaching lessen the burden of chronic disease in the workplace?

The role of employers is twofold: to create and sustain healthy work environments, and to support employees to improve their health. An opportunity for employers to support their employees would be to provide or facilitate the provision of health coaching, thereby reducing the impact of chronic diseases on their employees, and reducing drug and disability costs in the process.

Health coaching addresses the two most important factors to reduce the risk, progression, or management of a chronic disease: adherence to treatment and lifestyle changes. In order to achieve this objective, the approach of the health coach will be to find out:

why this disease/condition has happened
how do we modify what the patient is doing and
give the patient the skills to make the necessary changes in their life.

2. How can health coaching specifically lessen the burden of diabetes?

Regular monitoring of blood glucose levels is critical in managing type 1 and 2 diabetes. The key is to help people integrate insulin monitoring as part of their regular routine. New devices make it easier, but patients need to understand why and how to do it. Manufacturers of blood glucose meters are starting to recognize the importance of health coaching for the successful utilization of their units. One new blood glucose meter includes free health coaching sessions for all patients. Health coaching helps assist people in understanding the value and importance of exercising and good nutrition, as well as integrating their treatment within their lifestyle.

3. How would an employer go about implementing health coaching in the workplace?

We haven’t really got there yet. Some insurance companies offer health coaching, but programmes should offer more than just education: a self-empowerment component is also critical. Health coaching is really all about putting things in context to enable behaviour change and better outcomes.

Although Australia, the U.K. and the U.S. have well developed and accessible health coaching programmes, in Canada, resources are limited. In Australia, for example, health coaching is covered as part of the public health care system. Employers can access a variety of coaching programs, including one that my organization offers. I think many health care providers need better training in coaching techniques so that better outcomes may be achieved at a reduced cost to the health care system.

4. Which stakeholders should get involved?

The ideal approach is for all health care providers to be involved: pharmacists, primary care physicians, medical specialists, physiotherapists, personal trainers, etc. This integrated approach has been successfully implemented in small communities, where all stakeholders are able to routinely meet to provide self-management support for the individual. The group continually asks "How’s your action plan going? How can we support you?" at intervals which vary according to individual needs.

The increasing burden of chronic disease on the health system can no longer be ignored. An essential component to managing chronic disease is patient self-management, including adherence to treatment recommendations and healthy lifestyle behaviours. To engage and support patients to effectively self manage, healthcare professionals need to provide personal coaching as well as education. Employers will benefit as health systems ensure coordination along the continuum of care, integrating community-based, primary, and specialist care.