Q&A: How Pharmacists and Health Coaches Can Partner to Improve Chronic Disease Outcomes

This content is for general educational and informational purposes only and is not intended as medical advice. Patients should consult their physician or other qualified health care provider regarding changes to their medications or treatment plans.

In recognition of National Nutrition Month, Pharmacy Times spoke with Anna L. Lindahl, PharmD, clinical pharmacy specialist at UPMC Health Plan, and Ellen Sobota, MS, RD, LDN, NBC-HWC, lead lifestyle health coach at UPMC Health Plan, about the powerful connection between nutrition, medication adherence, and long-term chronic disease management. Both experts emphasized that nutrition and medication adherence are not competing priorities but synergistic pillars of health. Improvements in one area consistently reinforce the other, creating a positive feedback loop that supports lasting behavior change.

The discussion highlighted the critical role pharmacists play in framing nutrition as medicine, screening for social determinants such as food and medication access, and connecting patients to collaborative resources, including health coaches. Lindahl and Sobota made a compelling case that pharmacist–health coach collaboration is an essential infrastructure for helping patients move beyond an all-or-nothing mindset and build sustainable, personalized routines that improve both medication effectiveness and overall quality of life.

Pharmacy Times: Can you introduce yourself and explain your current title?

Anna L. Lindahl: I’m Anna. I am a clinical pharmacy specialist at the UPMC Health Plan, and I work with patients for management of chronic diseases.

Ellen Sobota: Hello. My name is Ellen. I am one of the lifestyle health coaches with UPMC Health Plan.

Pharmacy Times: As a pharmacist and a health coach, how do each of you view the relationship between medication adherence, nutrition, and long-term health outcomes?

Lindahl: I believe they go hand in hand. Improvements in one area often support another area, creating a positive feedback loop for long-term health. Building small and sustainable healthy habits can impact both nutrition and medication adherence and improve a patient’s confidence in managing their own health. It’s important to start off by saying that many long-term health problems are preventable through lifestyle. However, many of the patients I work with are already managing 1 or more chronic diseases—things like diabetes, high blood pressure, heart failure, and COPD [chronic obstructive pulmonary disease]—and both lifestyle modifications and medication adherence play a significant role in managing these chronic conditions and improving long-term health outcomes.

Sobota: I see nutrition and medication adherence as part of a health investment you can make at any stage. We know the research supports the long-term health outcomes of both. Nutrition helps with absorption and effectiveness of medications. Medications help to manage diseases and conditions they’re prescribed for. They work better together and go hand in hand.

Pharmacy Times: From your respective roles, how do you help patients see medications, nutrition, and lifestyle changes as part of a connected care plan rather than separate efforts?

Lindahl: I think we need to frame nutrition as a form of medicine. Over time, the food you eat can either act as a strong medicine for your body or slowly work against it. Lifestyle changes like diet, movement, and stress management can reduce or eliminate the need for—or the dosage of—certain medications over time. As pharmacists, we are well versed in medication [adverse] effects, so if we can help our patients avoid adding medications through lifestyle modifications, we should. The same is true for exercise. Exercise is medicine too—think of it as a prescription from your doctor. At the same time, when managing a chronic disease, there are certain medications that will improve your overall health and decrease morbidity and mortality risks, even with the best diet.

Sobota: I love a good sports reference. I see the connected care plan as a pit crew in a race that is essential to a racing team. Each pit crew member plays a role in the performance and outcome of a race, and each has their own specific task, but they must work together. That’s the same thing that we do for your health and wellness. If I’m discussing nutrition or physical activity with someone and it feels like we are also talking about their medications, that requires a discussion with the pharmacist. I’m going to make a recommendation and a referral so we can keep the nutrition and the physical activity part of the car rolling.

Pharmacy Times: What nutrition or lifestyle challenges do you most commonly see that make it harder for patients to stay adherent to their medications, and how do you address those challenges together?

Lindahl: I think people are busy and lead hectic lifestyles. It is easy to let our health drop to the bottom of our priority list if we’re not actively focusing on it. When life is busy, it’s important to make a plan to set yourself up for success. Working with a health coach or a pharmacist can be a time to sit down and make a plan. I talk to patients about organizing their medications for the week ahead of time and setting up a system of double-checking themselves. Maybe that means sorting a pillbox with morning and evening medications in their own separate compartments. If that’s too much, maybe we try to set them up with a pharmacy that does adherence packaging. It might mean setting an alarm on their phone to help them establish a routine, or pairing their medication with a habit they already have, like brushing their teeth. Making that plan is really the most important piece.

Sobota: Anna mentioned time and making a plan—I’m going to address access to food and medications. Limited access to food impacts our chronic conditions and may mean more medication. We’re addressing food access and medication routines within the initial discussions that we’re having with a member and screening for any additional resources that we can provide or recommend. For example, we can help get a member set up with food access through local food banks or food pantries, and we can assist with making a referral to a pharmacist or to a pharmacy department to discuss options such as medications being mailed or delivered to a member with limited transportation. Through our coaching programs, we’re there to partner with a member for their health and wellness goals and to provide conversations without judgment or shame.

Pharmacy Times: How can structured lifestyle or wellness programs—such as nutrition coaching, physical activity, or behavior change support—reinforce medication adherence and improve overall outcomes?

Sobota: Structured lifestyle and wellness programs can help build the confidence for our health habits, routines, and trends. I hear all the time, “I know what to do. I’m just not doing it,” because it can feel really overwhelming to feel like we have to change everything all at once. What we’re trying to do is break it down and make it manageable. We’re creating more realistic routines in one area, such as nutrition, which can translate to medication adherence and help make an improved overall outcome. Our brains love to draw on something successful in the past whenever we’re working to make those changes. One success in one area can help us build another success in another area.

Pharmacy Times: Can you share a real-world example where collaboration between a pharmacist and a health coach led to better adherence or measurable improvements in patient health?

Lindahl: I think a great example of this is with asthma and smoking cessation. When working with a patient with asthma, pharmacists stress the importance of adherence to their maintenance therapy, if prescribed, and having an asthma action plan. One of the most valuable parts of the discussion is screening for current tobacco use or smoking habits. We provide education on the importance of quitting smoking for their asthma management, and also help connect them to resources such as a health coach to discuss smoking cessation and provide them with the valuable tools that they need.

Sobota: A great example for me is a member who was struggling to obtain a medication from their pharmacy, as the pharmacy was regularly out of stock—and you can imagine how challenging that would become. The member gave up and stopped taking the medication. I made a referral to pharmacy, and the member was able to get set up with delivery of the medication. This helped everything else fall into place because there wasn’t the guilt, and there wasn’t the mental energy going into the fact that this person was not taking the medication. This helped them feel more confident. They devoted that mental energy to going to the gym and started working out regularly—the goal was twice a week—which, in turn, led to nutrition changes they had been struggling with. You can see how all of this progressed because of that one referral. We can help make things less all-or-nothing, and we can work together to find solutions that the member may not have known about.

Pharmacy Times: In recognition of National Nutrition Month, what practical, patient-friendly advice would you offer to help individuals align their daily nutrition habits with their medication regimens?

Lindahl: I’ll emphasize again: Make a plan and have a backup plan. Establish a system or routine that helps you stick to your plan, and don’t be afraid to ask for help. Check in with a pharmacist, a health coach, or your doctor for support in building a plan. Don’t be afraid to ask about the “whys” behind the “whats” to better understand your own health and medications. Know that you, the patient, and the choices you make are a key component to better health outcomes for you. If you do need a medication, know that adherence to that medication is the No. 1 factor in its effectiveness. Make a plan for taking the medication exactly as prescribed, and if you have any questions or concerns, talk to your doctor or pharmacist about it.

Sobota: Happy National Nutrition Month—one of my favorite months as a dietitian. Taking your medication as part of your health and wellness recipe is so important, as the dietary choices a person makes impact their medications as well. My best advice is very similar to Anna’s: You do not have to do this alone. Working with a dietitian, health coach, and pharmacist can help you find the best routine for you.

Pharmacy Times: Is there anything you would like to add?

Lindahl: I definitely want to thank you for having us on today to discuss this important topic. I also want to thank Ellen for joining us—your input is so valuable. I think collaboration between a pharmacist and a health coach can play such an important role in taking care of our patients to improve long-term health outcomes. It’s an exciting time in health care, specifically with all of the information and resources available to help manage chronic diseases today. Many people are very interested in changing their lifestyle to help manage these conditions outside of medication alone, and I think collaboration with health coaches is crucial to help get these patients the help that they need to reach their goals.

Sobota: Thank you so much to Anna, and thank you to everyone here for the time. I am greatly looking forward to all of the continued progress we have with our members as we move forward.

More information from Lindahl and Sobota can be found in Part 1 and Part 2 here.