Pulmonary Specialist Health Coach Consultation model: A randomized controlled trial

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Health Equity

Background:

• Socioeconomically disadvantaged patients with asthma and/or chronic obstructive pulmonary disease (COPD) face significant barriers to evidence-based care, particularly in resource-limited healthcare settings.
• These barriers hinder the effective management of chronic respiratory conditions in vulnerable populations.

Purpose of the Study:

• To evaluate the efficacy of a pulmonary specialist-health coach consultation model compared to usual care for patients with asthma and/or COPD.
• To assess the impact of the intervention on guideline adherence, patient outcomes, and quality of care.

Main Methods:

• A 16-week randomized-controlled trial comparing the intervention group with a usual care control group.
• The intervention involved a lay health coach facilitating remote pulmonary specialist recommendations to primary care clinicians for low-income, English- or Spanish-speaking adult patients.
• Primary outcomes included receipt of guideline-based care and medications; secondary outcomes covered education, quality of life, symptoms, and adherence.

Main Results:

• Intervention participants received 1.61-fold more guideline-based care than control participants (RR: 1.37-1.90).
• While planned analysis showed no significant difference in guideline-based medications, post-hoc analysis indicated improvement.
• Intervention patients experienced greater chronic lung disease education, improved breathing-related quality of life and symptoms, and higher patient-reported quality of care.

Conclusions:

• The pulmonary specialist-health coach model is a scalable approach to enhance the implementation of clinical guidelines in primary care.
• This intervention shows promise for improving care delivery for asthma and COPD patients in resource-limited settings.