Friday, November 29, 2019

The Potential Positive Impact of Lifestyle Coaches

Lifestyle coaches are an essential part of the CDC’s Diabetes Prevention Program (DPP). And while the CDC places an emphasis on getting community organizations to offer the DPP, the program can also be implemented in a primary care setting. Since lifestyle coaches facilitate the DPP in the setting, lifestyle coaches become part of the setting. And in one study, researchers in the Netherlands found that lifestyle coaches can be quite useful in a health care setting.

The DPP is a CDC program that was put in place to prevent or delay type 2 diabetes via weight loss, physical activity, a  healthy diet, and lifestyle modification. The program is a year-long program. The first six months consist of sixteen core sessions, where a lifestyle coach facilitates group learning. Through group interaction, the participants learn to eat healthy, engage in physical activity, reduce stress, and change behavior to improve health. And the last six months of the year-long program consist of at least six core maintenance sessions where topics from the first six months are reinforced.

In the above mentioned Netherlands study, the investigators set out to evaluate the implementation of lifestyle coaches in a health care setting. The investigators called the lifestyle coaches program  “coaching on lifestyle” or CooL. The investigators indicated that "Lifestyle coaches play a crucial role in ensuring the impact of CooL by actively networking, using clear communication materials and creating stakeholders’ support and understanding."

But the investigators also concluded that “the dissemination process of CooL still needs to be improved further." And that "It will take time before the lifestyle coaches have become accepted as valuable professionals who bridge the gap between the public health sector and health care settings.”

The CDC is trying to bridge the gap between the public health sector and health care settings in the U.S. with its DPP. The CDC quality-assures organization in the DPP via its recognition program. And primary care organizations are advised to send their patients to DPP recognized organizations in a health care setting or in a community setting.  Hopefully, the CDC will succeed at bridging the gap between the public health sector and healthcare settings in the U.S. This could improve health and lower health care cost.

Tuesday, November 19, 2019

Adapting the Diabetes Prevention Program Protocol to Intensive Behavioral Treatment

In 2011, Medicare started covering intensive behavioral therapy for the treatment of obesity. The treatment was part of Medicare’s preventive services. Therefore, an obese Medicare beneficiary would not have to pay for the treatment – no copay, no coinsurance and no deductible. As part of Medicare’s guidelines for delivering the Intensive Behavioral Treatment (IBT) services, it was recommended that providers use the 5 As counseling framework. However, Medicare recommended no specific protocol for the framework. So, the CDC’s Diabetes Prevention Program (DPP) protocol has been recommended for the IBT framework.

Medicare based its IBT coverage on the United States Preventive Services Task Force (USPSTF) evaluation. The USPSTF is an independent organization that evaluates preventive services, and rates the services with a letter grade of A, B, C, D of I. And the USPSTF gave IBT treatment service a grade of B. Specifically, “The USPSTF… found fair to good evidence that high intensity counseling combined with behavioral interventions in obese adults (as defined by a BMI ≥30 kg/m2) “produces modest, sustained weight loss.”

And the IBT should be consistent with the 5 As counseling framework. While there are variations of the 5 As framework, the framework shown on Medicare’s website may be summarized as follows: Acting within the framework, the provider should: Ask about and Assess a patient’s health risks; 2. Advise the patient; 3. Agree or collaborate with the patient; 4. Assist the patient in making healthy changes; and 5. Arrange to work with the patient in the future in support of the patient healthy activities.

The Diabetes Prevention Program, or DPP, is a patient-centered, value-based, evidence-based protocol. The DPP protocol consists of a one-year set of group sessions where a lifestyle coach delivers the sessions. The coach acts as a facilitator. The participants learn to follow a healthy eating pattern, increase physical activity, and modify behavior. The most important outcome is weight loss, since weight loss can lead to preventing or delaying type 2 diabetes in individuals with prediabetes.

Because weight loss is the most important outcome for both the DPP, and the IBT, using the DPP protocol within the IBT framework is a good approach. 

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