COACH Program: care from a distance for heart patients

A medical coaching program for patients with cardiovascular disease and/or type 2 diabetes successfully reduced risk factors in both Indigenous and non-Indigenous populations.


There is evidence that clinical practice consistently fails to adhere to evidence-based guidelines and achieve targets for cardiovascular risk factors like LDL-cholesterol and blood pressure, in most patients.


Associate Professor Margarite Vale from the Faculty of Medicine, Dentistry and Health Sciences, said The COACH (Coaching patients on Achieving Cardiovascular Health) Program, (TCP) was delivered by trained coaches and was highly effective in narrowing the ‘treatment gap’ – the gap between guideline recommended care and the care patients actually receive.


“Delivered by telephone and mail outs, this approach crosses geographic isolation, travel costs and the inconvenience of appointments. The benefits of this style of program could be beneficial nationwide and the results suggest the potential for it to be adapted for other chronic diseases,” Associate Professor Vale said.


Published recently in the Medical Journal of Australia, (TCP) was launched by Queensland Health in 2009 and has shown the program has successfully reduced risk factors and should be expanded nationally.


It is the first standardised coaching program targeting cardiovascular risk factors and delivered by telephone and mail-out statewide.


Using a standardised model of care, based on risk assessments and goal setting that reflect national disease management guidelines, coaches work with patients on the phone and through letters.


Up to 1962 patients with cardiovascular disease (CVD) and 707 with type 2 diabetes completed the program between February 2009 and June 2013. One hundred and forty-five were Indigenous Australians.


“Statistically significant improvements in cardiovascular risk factor status were found across all biomedical and lifestyle factors measured during the program, including improvements in serum lipid levels, blood glucose, smoking habit and alcohol consumption combined with increases in physical activity,” Associate Professor Vale said.


“We also found there was no significant difference in results between the Indigenous and non-Indigenous patients,” she said.


Telephone and mail-outs are unique to the chronic disease management model adopted by Queensland Health. Coaches identified the ‘treatment gaps’ in each patient’s management –between guideline recommended care and the care patients actually received, and coached patients to close their treatment gaps as patients worked with their usual doctors.


The COACH Program was developed at the University of Melbourne.


20 February 2015.