• Rachel Willard-Grace, Chris Chirinos, Jessica Wolf, Denise DeVore, Beatrice Huang, Danielle Hessler, Stephanie Tsao, George Su, and David H Thom.
• Department of Family and Community Medicine, University of California San Francisco, San Francisco, California Rachel.Willard@ucsf.edu.
• Ann Fam Med. 2020 Jan 1; 18 (1): 5-14.

PurposePoor adherence to medications is more prevalent for chronic obstructive pulmonary disease (COPD) than for other chronic conditions and is associated with unfavorable health outcomes. Few interventions have successfully improved adherence for COPD medications; none of these use unlicensed health care personnel. We explored the efficacy of lay health coaches to improve inhaler adherence and technique.MethodsWithin a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from urban, public primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive 9 months of health coaching or usual care. Outcome measures included self-reported adherence to inhaled controller medications in the past 7 days and observed technique for all inhalers. We used generalized linear models, controlling for baseline values and clustering by site.ResultsBaseline adherence and inhaler technique were uniformly poor and did not differ by study arm. At 9 months, health-coached patients reported a greater number of days of adherence compared with usual care patients (6.4 vs 5.5 days; adjusted P = .02) and were more likely to have used their controller inhalers as prescribed for 5 of the last 7 days (90% vs 69%; adjusted P = .008). They were more than 3 times as likely to demonstrate perfect technique for all inhaler devices (24% vs 7%; adjusted P = .01) and mastery of essential steps (40% vs 11%; adjusted P <.001).ConclusionsHealth coaching may provide a scalable model that can improve care for people living with COPD.© 2020 Annals of Family Medicine, Inc.

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