Opportunity for Australian community pharmacists to health coach

Background: The role of pharmacists is expanding beyond traditional dispensing duties. Pharmacist health coaching involves facilitating positive behaviour change; internationally, the service has produced favourable outcomes in patients with chronic health conditions. However, the provision of the service by Australian community pharmacists has not been reported. Across the community, there appears to be a lack of a clear understanding of what health coaching encompasses. Furthermore, the lack of a comprehensive competency framework means that there is no clear understanding by health professionals, and indeed researchers, of the skills and behaviours required with respect to undertaking health coaching. Internationally, although health coaching studies have investigated and reported the quantitative outcomes of pharmacist health coaching to date there is no qualitative data that supports the role of pharmacists as health coaches. Hence, there is a need to expand on the existing knowledge base regarding pharmacist health coaching. Objectives: To build an evidence-based comprehensive foundation about health coaching upon which a pilot Australian health coaching trial in community pharmacy could be designed, and implemented, and to evaluate the outcomes of a pilot pharmacist health coaching program qualitatively and quantitatively in Australia. Methods: A systematic review was conducted to identify sources related to pharmacy health coaching to extract the definitions of health coaching. The recurring terms/themes within the definitions of health coaching were noted in formulating a grounded definition (Chapter 2). Subsequently, a systematic review was carried out using the grounded definition to identify peer-reviewed papers referring to the competencies of health professionals engaged in health coaching (Chapter 3). Thereafter, a qualitative study compared the enabling competencies of health coaches against the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK), and the United States of America (USA) (Chapter 4). The foundation and behaviour change competencies within each of the competency domains in the generic health behaviour change competency framework (GHBC-CF), which provides a framework of competences at three different intervention levels- low, medium, and high was then mapped to the Australian pharmacist competency framework (Chapter 5). An additional systematic review was conducted engaging the grounded definition to evaluate sources referring to the modalities of pharmacist health coaching providing the greatest improvement in patient outcomes (Chapter 6). Semi-structured interviews with leaders in the pharmacy profession were carried out to qualitatively evaluate their opinions and attitudes towards health coaching in Australian community pharmacies (Chapter 7). The outcomes of this work provided the foundation to undertake a pilot community pharmacy-based health coaching study. Pharmacists provided three health coaching sessions to 20 participants with poorly controlled hypertension at monthly intervals. Changes in participants' blood pressure, medication adherence, and the stages of change (SOC) with respect to the modifiable health behaviours; diet, exercise, and medication management were assessed (Chapter 8). The beliefs, opinions, attitudes, and experiences that participants who receive health coaching have towards the service were thematically analysed at baseline and post-study as were the views of the pharmacist health coaches (Chapter 9). Results: A grounded definition of health coaching was established (Chapter 2), as were nine key competencies of health professionals engaged in health coaching (Chapter 3). The competency frameworks for pharmacists from countries in which health coaching interventions have been successfully implemented underpinned the competencies previously identified as being required to health coach. However, the health coaching competency "demonstrates confidence" appeared to be absent in the competency frameworks for pharmacists from AUS, CAN, and NZ (Chapter 4). Examining the competencies Australian pharmacists required in more detail, further mapping indicated that basic behaviour change interventions were within the scope, but knowledge and skills for intensive behaviour change interventions such as health coaching needed to be further developed (Chapter 5). The modalities used by these pharmacists to health coach included face-to-face, telephone, or a combination of approaches. In each instance, coaching led to improvements in the patient's clinical and non-clinical health outcomes and identification of the most pragmatic health coaching approach was not possible (Chapter 6). Stakeholders identified key barriers and facilitators to implementing health coaching into the Australian community pharmacy such as lack of pharmacist knowledge and improved management of chronic disease, respectively (Chapter 7). The outcomes of a pilot health coaching study in the community pharmacy showed reductions in blood pressure in participants with poorly controlled hypertension and positive changes to their SOC and health behaviours (Chapter 8). The beliefs, opinions, attitudes, and experiences of participants also changed because of pharmacist health coaching. While interviews with the pharmacists revealed several factors relating to the implementation and provision of health coaching into Australian community pharmacy practice (Chapter 9). Conclusion: A comprehensive study that examined several different aspects of pharmacist health coaching formed the framework for a pilot health coaching study in an Australian community pharmacy. Quantitative analysis of the study outcomes revealed improvements to participant blood pressure as well as their health behaviours. Interviews with pharmacist health coaches showed several factors that would need to be carefully considered if health coaching were to be implemented into community pharmacy practice nationally, these elements were analogous to those identified by key stakeholders in the industry. This pilot demonstrates the potential for Australian pharmacists to provide health coaching. The work also identifies additional training is required to upgrade pharmacists' knowledge and skills to enable them to provide this service.

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