Does the Modality Used in Health Coaching Matter? A Systematic Review of Health Coaching Outcomes

Figures & data

Table 1 Search Strings for Three Stage Search

Database	Search Strategy
CINAHL	Search (health coaching AND pharmacy AND health) Limiters- English language, peer reviewed, research article Search (pharmacy health coaching AND pharmacist) Limiters- English language, peer reviewed, research article Search (pharmacist coach AND (telephone OR text message OR video OR SMS OR face to face) Limiters- English language, peer reviewed, research article Search (#1 AND #2 AND #3) filters: English; Peer Reviewed; Journal Article; Published Date 2000-present
EMBASE	Search (health coaching AND pharmacy AND health) Search (pharmacy health coaching AND pharmacist) Search (pharmacist coach AND (telephone OR text message OR video OR SMS OR face to face) Search (#1 AND #2 AND #3) filters: English, article
PubMed	Search (health coaching AND pharmacy AND health) Filters: humans, English, journal article Search (pharmacy health coaching AND pharmacist) Filters: humans, English, journal article Search (pharmacist coach AND (telephone OR text message OR video OR SMS OR face to face) Filters: humans, English, journal article Search (#1 AND #2 AND #3)
PsychINFO	Search (health coaching AND pharmacy AND health) Limiters: English, peer reviewed Search (pharmacy health coaching AND pharmacist) Limiters: English, peer reviewed Search (pharmacist coach AND (telephone OR text message OR video OR SMS OR face to face) Limiters: English, peer reviewed Search (#1 AND #2 AND #3)
SCOPUS	Search (health coaching AND pharmacy AND health) Limit to article and English Search (pharmacy health coaching AND pharmacist) Limit to article and English Search (pharmacist coach AND (telephone OR text message OR video OR SMS OR face to face) Limit to article and English Search (#1 AND #2 AND #3)

Table 2 Inclusion and Exclusion Criteria for Obtaining Sources for Abstract and Full Paper Review

Inclusion

Exclusion

Sources published in print format or on the internet. Sources that include the key terms (patient-centered, facilitate, motivation, goal-setting, behavior change, improve health) used to define health coaching as per the grounded definition Sources that refer to the pharmacist as the health coach. Sources containing text that refer to the method that the pharmacist used to health coach patients. Articles between 2000-present.

Sources published in a language other than English. Sources that define health coaching outside the context of pharmacy. Sources that do not include the word “coaching”. Sources that do not define the method used to heath coach patients. Articles for which we could not source full text.

Table 3 Summary of Included Studies

Reference and Country	Type of Pharmacist Health Coaching	No. of Sessions	Duration of Session	Training Provided to Health Coaches	Population Being Coached	Outcomes	Cost-Effectiveness Measured	Positives to the Health Coaching Technique	Negatives to the Health Coaching Technique
MacLean, White, Broughton, Robinson, Shultz, Weeks, Willson^Citation23 United States	Telephone	Weekly	~10–20 minutes	Trained in motivational interviewing and problem solving.	Diabetes	For participants with HbA1c levels > 7.0% before coaching, the pre to post-test change in HbA1c was 0.5% for control subjects and 1.3% for coaching subjects. 79.2% of coaching participants stated their coach helped better control their diabetes. 50.1% of coaching group participants expressed interest in receiving further coaching.	Paper concludes that student pharmacist health coaching is a low-cost method to improve self-management of diabetes, but does not actually measure cost effectiveness.	The service is sustainable using students as coaches Improves patient care while providing a teaching environment for students. It provides social affiliation and support for patients, which is valuable for patients living in rural areas.	Although improvement in patient outcomes were observed at end of study (8 weeks), long term clinical impacts of telephone coaching is unknown. Participants initially wanted to achieve goals for coach.
Fera, Bluml, Ellis^Citation26 United States	Face-to-face	µ=6	µ=51 min	Pharmacists required to complete an approved diabetes training program.	Diabetes	Improvements in clinical outcomes.	Yes Average total care costs per patient reduced.	Employer funded. Involved face-to-face sessions at various sites allowing flexibility in patient care, Done privately. Direct assessment of clinical outcomes.	Sessions were long. Time-consuming. May require re-engineering of the pharmacy site in order to offer service.
Luder, Frede, Kirby, King, Heaton^Citation34 United States	Face to face	Monthly for uncontrolled patients Annually for controlled patients	No mention	No mention	Patients taking at least one medication for diabetes/hypertension.	Patients with controlled conditions had more confidence Patients with uncontrolled conditions had more barriers to managing their health. African American patients had more confidence (4.44) in performing health behaviours than white patients (4.21) p-value 0.28. Patients with uncontrolled conditions were more likely (3.47) to enrol when financial incentives were offered compared to the controlled group (3.23. p-value 0.261).	No	Employer funded. Patients received financial incentives for participation.	Patients may have tried to please the coach and responded more favourable to questions.
Barnett, Flora^Citation37 United Kingdom	Face-to-face	1	No mention	Two-day training course delivered by a health psychologist.	All hospital pharmacy patients.	Patients were happy with the consultation.	No	Service provided in hospital pharmacy. Patients coached depending on receptivity to the service. Not a one size fits all approach.	Lack of privacy during service provision.
Wertz, Hou, DeVries, Dupclay, McGowan, Malinowski, Cziraky^Citation36 United States	Face-to-Face	µ= 8.1 ± 5.2	No mention	No mention.	Diabetes/hypertension.	Patients more likely to have additions or changes to their medications. Reductions in blood pressure, lipid levels and HbA1c levels.	Costs related to hypertension and diabetes were increased.	Employer-sponsored service. Patients received financial incentives for participation. Direct assessment of clinical outcomes.	Short term increase in costs at the initiation of the service.
Brook, Van Hout, Nieuwenhuyse, Heerdink^Citation24 Denmark	Face-to-face and take home video	3	No mention	Nil. States pharmacists already have the communication skills to health coach.	Newly diagnosed patients starting on a non-tricyclic antidepressant for the first time.	Improvement in drug attitude inventory (DAI) score.	Cost-effectiveness studies were not performed. Though reports that similar interventions can have significant changes in patient’s drugs which saves more than the cost of the intervention.	Pharmacists were capable of coaching patient’s alongside conventional duties.	Coaching may impact daily routine of the pharmacy. The pharmacist’s busy schedule may make it difficult to make follow-up appointments. The pharmacy setting may hamper confidential conversations.
Akers, Meer, Kintner, Shields, Dillon-Sumner, Bacci^Citation31 United States	Home visits and telephone	Variable- depended on the mode of referral	M =1.5 hours	No mention	Depended on the mode of referral	Pharmacists identified more drug therapy related problems.	No	Health coaches were reimbursed by community-based organisations. Pharmacist coaches provided high level care outside the traditional pharmacy setting.	Access to patient history required prior to home visit. Requires travel of the coach to patient’s home. Travel costs will be incurred. Requires laptop, tablets and/or wireless internet connection.
Engelhard, Lonneman, Warner, Brown^Citation44 United States	Face-to-face and telephone	Variable	No mention	Two-hour online training including motivational interviewing techniques as well as disease state-specific training.	Diabetes	Coaches helped patients reach their goals and patients would recommend the service to their friends/family.	Cost-effectiveness studies not performed Health coaching with pre-med students showed that support to high-risk patients helped to reduce overall health care costs.	Student coaches learned how to provide support to those managing chronic illnesses.	Training is not generalizable to a broader audience and has not been accredited by an outside body. Coaches and patients felt pressured to please each other.
Bosmans, Brook, Van Hout, De Bruijne, Nieuwenhuyse, Bouter, Stalman, Van Tulder^Citation39 Netherlands	Face to Face and take home video	3	µ= 13 and 20 minutes	No mention	Newly diagnosed patients starting on a non-tricyclic antidepressant for the first time	No significant difference in adherence to antidepressant medication.	The costs in the intervention group were higher.	The intervention was easy to implement.	Coaching may impact the daily routine of the pharmacy. The pharmacist’s busy schedule may make it difficult to make follow-up appointments. The pharmacy setting may hamper confidential conversations.
Brook, Van Hout, Nieuwenhuysea, De Haan^Citation18 Denmark	Face to Face and take home video	3	No mention	Pharmacists already have the communication skills to health coach.	Newly diagnosed patients starting on a non-tricyclic antidepressant for the first time.	Coaching was more effective in patients with lower education levels.	No mention	Pharmacists were capable of coaching patient’s alongside conventional duties.	Coaching may impact the daily routine of the pharmacy. The pharmacist’s busy schedule may make it difficult to make follow-up appointments. The pharmacy setting may hamper confidential conversations.
Pounds, Offurum, Moultry^Citation45 United States	Face to face, email, texts, and telephone phone calls.	Weekly sessions with student pharmacists	1 hour	Six hours of training- motivational interviewing techniques as well as disease state-specific training.	Hypertension	Students were confident in their ability to perform coaching (85%), though did not feel comfortable about educating patients about hypertension (86%).	No mention	Students were able to confidently coach patients.	Students may need additional training to prepare them for challenges associated with engaging individuals about making changes to their health.
Wennberg, Marr, Lang, O’Malley, Bennett^Citation38 United States	Telephone coaching supplemented with web-links, video and print materials.	Variable; 5 sessions for patients in the enhanced support group and 3 sessions for those in the usual support group.	No mention	States training provided. No details on specifics.	Various medical conditions.	The average monthly medical costs was lower in patients in the enhanced support group.	The average monthly medical costs was lower in patients in the enhanced support group. The reduction in costs was mainly attributed to a reduction in annual hospital admissions.	The telephone sessions were supplemented with additional modes of delivery according to patient needs.	The patient’s required health insurance in order to receive the service.

Figure 1 PRISMA flow chart of the literature search and study selection.

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