The PROLIFIC Study and the Concept of the Health Coach
The PROLIFIC trial [1] was published yesterday in Lancet Global Health. This trial is unique for two reasons. The first is that it is one of those rare, well-conducted, randomized control trials (RCT) out of India. The second is that it uses a unique concept that is practical and can actually make a difference in the real-world.
In this RCT, first degree family members of patients who had coronary artery disease before the age of 55 were randomized into two groups. One group received usual care with advisory every year. The second group was subjected to more intense work-up. A healthcare / social worker visited their homes at least once in two months in the first year and then monthly in the 2nd year for an average of 13 times in two years.
The aim was to see how each group did with respect to four cardiovascular health parameters; blood pressure below 140/90, fasting plasma glucose of 110 mg/dl or less, serum LDL-C less than 100 mg/dl and tobacco abstinence. The endgame assumption is that those who have better control over these parameters will live long, healthy in alignment with our atmasvasth quest.
The social worker was trained in advance to measure blood pressure, check blood sugar and give advisory on physical activity (at least 30-60 mins of walking per day), reducing salt intake to a quarter of a tablespoon per day per person, sensible eating including local fruits and vegetables (4-5 servings per day) and helping with other lifestyle measures.
These healthcare non-physician workers received intense, initial training with refresher courses every six months. For the purpose of the study, trained nurses were used for baseline and annual assessment, while all the other deliverables were by the non-physician workers.
The second group did twice as well as the usual care group. In other words, the group subjected to home visits by non-physician healthcare/social workers achieved an outcome two times better than those who were left to manage things on their own.
We don’t need doctors to deliver high quality primary preventive care. Non-medical people with adequate training can easily give advise, measure health parameters and help identify those who need to be seen by nurses or doctors, thus not only reducing the burden on the healthcare system, but also helping to create a more healthy population.
Basically, we need health coaches…people who are passionate about being healthy and keeping those around them healthy. Once a health coach has received training on a plan similar to the 13-points atmasvasth guide, they can easily manage a few families, talking to them and/or visiting them once a month, checking individual diaries for adherence to the set goals and helping the families measure and manage their own health parameters. It’s not just cardiovascular risk management. The same health coach can nudge the elderly to get vaccines, if needed, try and convince women over 40 years of age to get their yearly mammograms, survey the house to ensure a falls-free environment, help them access adequate health insurance and so and so forth.
As the PROLIFIC study shows, working with a family, which shares similar genetic traits and environmental and cultural factors makes it easier to achieve health goals. The family can act as its own internal support system to make sure no one is left behind. Eventually if we have 100,000 health workers from all walks of society (home makers, teachers, professionals, writers, software engineers,…basically anyone interested in improving the health of others), working part-time, we can easily guide at least 50,00,000 (50 lakh people) and eventually even more, to adopt measures to live long healthy. A good health coach could start with 4-5 families, and then depending on the time and interest, easily manage the health of at least 100-200 people.
This is not just an “Indian” issue, but something that can be implemented worldwide. All we need are physician trainers to train health coaches with a defined plan using face-to-face visits and paper-based diaries.
Footnotes
1. Jeemon P et al. Efficacy of a family-based cardiovascular risk reduction intervention in individuals with a family history of premature coronary heart disease in India (PROLIFIC): an open-label, single-centre, cluster randomised controlled trial. Lancet Glob Health 2021; 9: e1442–50
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