To address the burgeoning primary care demand-capacity imbalance, team-based models using medical assistants (MAs) to provide evidence-based, disease self-management support have been proposed. Randomized controlled trials (RCT) have shown MA health coaching improves clinical outcomes in chronic disease populations; however, pragmatic research is needed to evaluate effectiveness and feasibility in real-world health settings. Thus, we adopted a unique, cluster RCT to compare MA health coaching with usual care in N=600 adults with T2D, plus HbA1c ≥8.0% and/or SBP ≥140 mmHg, and/or LDL-C ≥100 mg/dL. Importantly, this in-progress trial examines implementation and outcomes across two very distinct settings: a federally qualified health center (Site A; majority Hispanic/Spanish-speaking, low SES patients; M age = 58.2) and a large, private insurance-based health system (Site B; majority non-Hispanic white/English-speaking, middle/upper SES; M age = 73.4). To facilitate integration with routine clinic processes, existing MAs are trained to perform at top of license, and EMR-based risk stratification identifies qualifying patients presenting to clinic each day. MA health coaches join primary care visits to understand the care plan and provide self-management support in conjunction with medical visits and by phone for 1 year. Dosage and intervention components (medication reconciliation, assessment, goal setting, lab review) are tailored to patient needs. A process evaluation revealed differences between Sites A and B in session frequency (M = 7 ± 3 vs. 4 ± 2), duration (M = 20 ± 15 vs. 14 ± 10 minutes), and focus (healthful eating vs. blood pressure monitoring) (all ps<.05). Marked differences in the need for, and focus of self-management support parallel the relative differences in clinical control in these two distinct T2D populations (M A1c = 10.4 ± 1.8 vs. 9.4 ± 1.7%; M LDL-C = 142.1 ± 34.6 vs. 129.5 ± 21.7 mg/dL, ps<.05). Valuable, site-based implementation successes and challenges will be presented.


T. Clark: None. L. Gallo: None. J.A. Euyoque: None. K.L. Savin: None. J.I. Bravin: None. H. Sandoval: None. D. Lara Ledesma: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. A.L. Fortmann: None.


National Institutes of Health

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at