Evidence map›Paper›PMID 25755034›Full record

Trial reportAnnals of family medicine2015

Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial.

Rachel Willard-Grace, Ellen H Chen, Danielle Hessler, Denise DeVore, Camille Prado, Thomas Bodenheimer, David H Thom

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of family medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04082611 (The PREVENTION Trial), which is not on this map. Cited by 79 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
79citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04082611 nacompletednot on this mapstarted 2019, after this paper: background citation

The PREVENTION Trial: Precision Recommendations for Environmental Variables, Exercise, Nutrition and Training Interventions to Optimize Neurocognition

TypeinterventionalSponsorSaint John's Cancer InstituteRan2019 to 2025Enrolled97ConditionsAlzheimer Disease, Mild Cognitive ImpairmentArmsData-Driven Clinical Recommendations, Coached Data-Driven Clinical Recommendations
3 · Its place in the literature

Who cites it

79 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  19. Delivery of Health Coaching by Medical Assistants in Primary Care.Journal of the American Board of Family Medicine : JABFM
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19 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Rachel Willard-GraceDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California willardr@fcm.ucsf.edu.
Ellen H ChenDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California Silver Avenue Family Health Center, San Francisco Department of Public Health, San Francisco, California.
Danielle HesslerDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Denise DeVoreDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Camille PradoDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Thomas BodenheimerDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California.
David H ThomDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, California.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeHealth coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care.

methodsWe conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California. The primary outcome was a composite measure of being at or below goal at 12 months for at least 1 of 3 uncontrolled conditions at baseline as defined by hemoglobin A1c, systolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Secondary outcomes were meeting all 3 goals and meeting individual goals. Data were analyzed using χ(2) tests and linear regression models.

resultsParticipants in the coaching arm were more likely to achieve both the primary composite measure of 1 of the clinical goals (46.4% vs 34.3%, P = .02) and the secondary composite measure of reaching all clinical goals (34.0% vs 24.7%, P = .05). Almost twice as many coached patients achieved the hemoglobin A1c goal (48.6% vs 27.6%, P = .01). At the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (41.8% vs 25.4%, P = .04). The proportion of patients meeting the systolic blood pressure goal did not differ significantly.

conclusionsMedical assistants serving as in-clinic health coaches improved control of hemoglobin A1c and LDL levels, but not blood pressure, compared with usual care. Our results highlight the need to understand the relationship between patients' clinical conditions, interventions, and the contextual features of implementation.

Indexed as

Allied Health PersonnelPovertyAdultBlood PressureCholesterol, LDLCounselingDiabetes Mellitus, Type 2FemaleGlycated HemoglobinHumansHyperlipidemiasHypertensionLinear ModelsMaleMiddle AgedPrimary Health CareCholesterol, LDLGlycated Hemoglobinhemoglobin A1c protein, humanallied health personnelchronic disease managementhealth educationmedical assistantsmotivationpractice-based researchprimary carevulnerable populations

Identifiers

PMID25755034
PMCPMC4369595

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.