Prescription for a Healthier Community
When Allegheny pre-health student Gabby Izzo ’14 first visited 89-year-old military-service veteran Rudolph Bradick, she noticed he was confused about taking his medications, a potentially life-threatening issue.
Bradick, a Meadville resident, knew he was supposed to take 15 pills each day, but he had prescriptions from several physicians and was unsure of the correct dosage, which ones to take when and how to obtain refills.
That’s where Gabby, a member of Allegheny’s health coaching program – an innovative partnership among Allegheny, Meadville Medical Center and the hospital’s Community Care Network – comes into the picture. In her role as a health coach, Gabby regularly meets with Bradick and identified this challenge. She then shared his health status and confusion about his medications with his health care providers from Meadville Medical Center. The health care team verified his prescriptions and worked with Bradick to create a medication schedule he could easily follow.
“That’s an example of what the health coaching program is all about,” says Kirsten Peterson, advisor to Allegheny’s health professions students. “Our student health coaches are often the eyes and ears of the doctors, helping to identify potential barriers to care before the patient needs to be admitted to the hospital. This gives the students valuable, real-world experience, and it gives patients access to another member of their health care team.”
Focusing on Preventive Medicine – STAT
The concept of bringing health coaching to Allegheny came from Barry Bittman, M.D., Meadville Medical Center’s chief innovation officer. Dr. Bittman envisioned a program that would allow Allegheny pre-health students to regularly meet with patients experiencing chronic conditions and having a history of frequent hospitalizations. The health coaches would serve in a preventive role by helping patients adhere to doctors’ orders.
“When studying this patient population, we realized that they were often leaving the hospital and going back to the same situation that may have led to the hospital admission,” Dr. Bittman explains. “We wanted to develop a program that would enable us to become responsible for the whole person and take that responsibility beyond the hospital’s four walls.”
Associate Professor of Philosophy Steven Farrelly-Jackson then started to work with Dr. Bittman to enable his ideas for this unique health coaching partnership to become a reality in the Allegheny curriculum. Dr. Bittman says Allegheny is the first college in the country to use its students as health coaches. Several other schools, such as St. Lawrence University, Gannon University and the College of Wooster, are developing similar programs.
The Allegheny initiative started two years ago and now involves almost 400 patients.
How much impact has the program had? Dr. Bittman has the data to support its positive results. As an example, during the first year of the health coaching program, patients from the Community Care Network (a hospital-wide effort comprised of a physician-directed team of nurses, counselors, social workers, nutritionists and ancillary support personnel) experienced a 45 percent reduction in hospital admissions and a 25 percent reduction in emergency room visits compared to the previous year. Patient outcomes also improved in multiple areas such as control of diabetes. Additionally, and as a direct result, he says, the cost of care for these patients also was reduced substantially.
This is how the system works.
Students are eligible to apply to the health coaching program during their sophomore year. Although most of the students are pre-medical, the class also includes students studying public health, psychology, neurosciences and economics. There were 23 students participating during the fall 2013 semester.
The program begins with a two-credit interactive seminar coordinated by Community Care Network Director Tracy Meure, RN, and Professor Farrelly-Jackson. Faculty members include Dr. Bittman, Randy Zelen, M.D., Professor Farrelly-Jackson and Meure, along with nutritionists, psychologists, social workers and a health care attorney.
“The seminar is designed to lay down the theoretical foundation in some of the key areas of community health, such as nutrition, cardiovascular disease, obesity and mental health issues,” Professor Farrelly-Jackson explains. “In the medical ethics component of the course, we discuss many of the behind-the-scenes challenges of health care, such as the plight of uninsured and underinsured patients.”
During the second part of the semester, students review case studies and are placed into role-play situations where they learn how to interact with patients and how to help them comply with medical instructions. “They also do observations and shadowing experiences in other parts of the hospital, such as dialysis, primary care, radiology and the emergency department,” Peterson says. “The medical professionals have been very generous with their time.”
Health coach and biology major Sean Loose ’14 believes the seminar helped him better grasp how community, and national, health care systems operate.
“This experience has made me understand how much more there is to working in a health care field than just treating a patient’s symptoms,” he says. “Whether visiting a patient or doing hospital rounds or community health observations, experiencing firsthand what is involved in community health care gave me an understanding that could not be taught solely in the classroom.”
A Healthy Dose of Experience
After the seminar, students then embark on the health coaching itself where, under Meure’s direction, they work as part of a community health care team that includes a physician, nurse, social worker and nutritionist. Each student is then assigned to patients, with the student being responsible for scheduling regular meetings. The students attend one of three weekly case review sessions, which are conducted by the core team, to provide an update on their patients.
During the patient visits, students perform tasks such as reminding them of their appointments, making sure they are following their prescribed diet, checking to make sure their environment is clean and safe, and helping them organize their medications.
“As an example, one of my patients, a 57-year-old woman, had been instructed to check her blood sugar daily, but she wasn’t complying,” explains health coach Gabby Izzo. “Each week I would show her how, but she just wouldn’t follow through.
“After three months, I decided to take a different approach and drew the steps for her on paper,” she continues. “The next week, she greeted me at the door, hugged me and said she couldn’t wait to show me her blood sugar diary. She had finally taken her reading! That was not only my most rewarding experience as a health coach, it also was the most important experience of my life.”
Some students, like pre-health student and former health coach Andrew Culp ’14, spend a lot of time during their patient visits simply talking.
“I had a 67-year-old patient who had lost his wife and was very depressed,” Andrew explains. “He was dealing with so much emotionally, so he really just wanted to talk. Now, one year later, his emotional and physical health has drastically improved.”
Says Dr. Bittman: “The students are phenomenally effective at what they do.” He adds that 87 health coaches now have graduated from the program. “Their effectiveness is not only reflected in their brilliance, but also in their ability to develop meaningful relationships with our patients. By getting to know them, they’re able to change the willingness of a person to go along with a mutually developed plan. They’re able to break through and truly understand the patient, which can be rather challenging at times.
“When we began the program, I never knew we’d be able to change behavior like we are. The fact is, these students are helping to save lives,” he continues. “I feel our health coaches are the most effective members of our team in helping to change chronic behavior.”
“I believe the health coaching program is one of the most worthwhile and exciting programs in which I’ve been involved,” adds Professor Farrelly-Jackson. “I enjoy seeing how the students develop from the seminar to the internship. They really come into their own through the health coaching experience; it’s immensely valuable for their intellectual and moral growth.”
Patients are voluntarily enrolled in the health coaching program through referrals from the physicians or through hospital screenings. Once a health coach graduates, a new student is assigned to the patient.
In addition to hands-on experience for the students, healthier lifestyles for patients and decreased admission rates for the hospital, Peterson also believes health coaching has contributed to an increase in the quality of students’ personal statements they are required to write when applying to medical schools. “Health coaching allows students to have something tangible to write and speak about, which sets them apart from their peers at other schools,” she says.
Now that Gabby and Andrew have applied to medical schools, how do they think their experience has impacted their futures?
“I always thought I wanted to work with children and expectant moms, but because of this experience, the possibility of working with adults has become more appealing,” Gabby says.
“Before this experience, I never considered becoming a primary care physician or specializing in internal medicine. Now it’s a real possibility,” Andrew adds. “I feel I have a much better understanding of what medicine is about. I will definitely carry the skills I learned through health coaching with me through the rest of my career.”
“Allegheny has been a phenomenal partner in allowing this program to succeed,” Dr. Bittman adds. “It’s truly a win all around. The students are getting the exposure they need before they commit themselves to a graduate career, the patients are getting the care they need from a dedicated group of people who truly want to make a difference, and the community is benefiting because we’re not adding to the cost of health care. I believe this is the future of our health care system.”
By Heather L. Grubbs