Collaborative learning to examine the feasibility and uptake of whole health coaching for rural-residing Veterans with multiple chronic conditions

Abstract: Introduction: Among rural communities, there is a growing occurrence of persons with multiple chronic conditions (MCC) who have many unmet health care needs. Innovative interventions are needed to help address these needs. The purpose of this article is to describe the feasibility and uptake of a Whole Health System (WHS) health coaching support for rural-residing Veterans with MCC. Methods: This was a prospective qualitative case study of the development and early implementation of two types of health coaching support conducted at the VA Portland Health Care System. The two types of support offered were a health coach alone or a health coach plus remote patient monitoring-home telehealth (RPM-HT). Two clinical teams collaborated on the planning and implementation of the interventions using a collaborative learning process. The observations from this process were then used to conduct a formative evaluation using the Mobilizing Integrated Promoting Action on Research Implementation in Health Services (Mi-PARIHS) toolkit. Results: Of the 56 Veterans offered health coaching support, 6 (10.7%) engaged with the health coach. Among the 32 Veterans offered health coach plus RPM-HT support, 12 (37.5%) participated. Many factors contributed to the limited engagement of Veterans in the WHS coaching interventions including system-, clinician-, and patient-level concerns. Discussion: Our study examining the feasibility and uptake of providing WHS health coaching support highlights the complex care needs and numerous challenges of providing this type of support. Moreover, the formative evaluation using the Mi-PARIHS toolkit reinforced specific barriers that need to be addressed in future implementation efforts of providing person-centered care supported by health coaches. Finally, there is an urgent need for effective solutions given the health disparity gaps in rural communities, shortage of health care professionals, limited access to specialty care and closure of rural hospitals, and the estimated doubling prevalence of MCC over the next 25 years.