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Health Promotion and Wellness: Relevance and Implementation Strategies

Health Promotion and Wellness: Relevance and Implementation Strategies. Circle of Life www.CircleofLife.net. The Circle of Life. Self-Inquiry Assessment Form. Trends in Health Care. Wellness and health promotion Disease management Complementary medicine Parish nursing Cluster services.

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Health Promotion and Wellness: Relevance and Implementation Strategies

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  1. Health Promotion and Wellness:Relevance and Implementation Strategies Circle of Life www.CircleofLife.net

  2. The Circle of Life Self-Inquiry Assessment Form

  3. Trends in Health Care • Wellness and health promotion • Disease management • Complementary medicine • Parish nursing • Cluster services

  4. Methodology • Provide opportunities that are: • Experiential • Relevant • Life inspiring • Community building • Leverage practical, applied spirituality: • Tools • Support • Assistive Accountability

  5. Utilization Frequency and Cost COST Medical Care Prevention and Health Enhancement Programming Self Care and Citizen Self Reliance FREQUENCY

  6. What are the most important complementary services? Those that are safe, effective at a minimal cost: • Group health improvement activities - - group education - support group, study group - exercise - mind/body - Yoga, Tai Chi, Qigong, meditation • Counseling or coaching - nutrition, informed choice • Proactive triage - nurse on phone, demand management

  7. Medical visits - 75% could be handled through self-care, 25% require contact with a provider (no visit), 10% require an office visit (physician or nurse practitioner). Health Decisions, Demand Management Donald Vickery, MD Of the $1 trillion in annual expenditures 33% is spent on care deemed to be avoidable. Piper Jaffray Research, Health Care Information Systems Industry, 6/97

  8. Pressures in the System • Challenge of Chronic Illness • Negative Drug Reactions • Iatrogenic Incidences • Major % of disease is behavioral • Immense media attention • Anti-aging and longevity • Alternative and complementary medicine

  9. Chronic IllnessJAMA, C. Hoffman, et al, November, 1996 • 1970 - 21 family caregivers/85 year old • 1987 - 76% of direct medical expenses • 1996 - 7 of 10 admissions are for chronic illness • 1996 - 99 million, 45% of population, $470 billion • 2020 - 134 million, 60% of population, $685 billion • 2030 - 6 family caregivers/ 85 year old • Integration of complementary services that are safe and effective may help to resolve some of this challenge.

  10. Adverse Drug Reactions • JAMA April, 1998, Lazarou, et al • 1998 Major Causes of Death - • Heart disease • Cancer • Adverse drug reactions • 5,000,000 drug complications/year • 200,000 deaths/year • $4 Billion in medical costs per year

  11. Medical Error - Iatrogenic Illness • 1988 Rand Corporation - • 25% of heart, stroke, pneumonia deaths • 1991 Time Corp- • 80,000/year = 2x annual auto deaths • 1994 JAMA, 272:1851-1857 - Leape, et al • 180,000 deaths per year • 1997 Harris Poll - 100 million have experienced or know someone who has

  12. 1999 - 2000 Congressional HearingMedical ErrorInstitute of Medicine • At least 44K to 98K deaths per year due to adverse medical events • More iatrogenic deaths than motor vehicle accidents, breast cancer, or AIDS • Medical mistakes cost between $17 billion and $29 billion per year

  13. An Act of Congress Created The Office of Alternative Medicine (OAM) It was then upgraded to The National Center for Complementary and Alternative Medicine

  14. Complementary and Alternative Medicine - CAM The Economics: • $13 Billion, 1991 • $ 54 Billion, 1997

  15. Between 1990 and 2000 The budget of NCCAM was increased 3000%

  16. White House Commission on Complementary and Alternative Medicine Policy Added a new area to its investigation on self-care and self-healing because a strong theme in their testimony regarded personal health improvement through personal action.

  17. The House Task Force on Guiding Principles for Health Care Two Key principles: • Health Creation • Self-Healing and Self- Managed Care

  18. Health Futurists • Strongest move: Health Improvement as a key to Integrative or Complementary Medicine • Cost Pressures: Alternative Therapies are Cost Shifting Self-Care is Cost Cutting

  19. 70%of disease is preventable Healthy People 2000, DHHS, 1991, #91-50213 National Center For Health Statistics, DHHS, 1992, # 92-1232 8 of 9 causes of disease are preventable New England Journal of Medicine, Fries, Koop, et al, 329:321-325, 7/93

  20. Chain of Causation 10 Leading Causes of Death 9 Actual Causes of Death Root Causes of Death 1. Heart Disease Tobacco Lack of information 2. Cancer Diet/activity patterns Lack of life skills 3. Cerebrovascular disease Alcohol Lack of connection 4. Accidents Microbial agents External & internal stress 5. COPD Toxic agents Low self-esteem 6. Pneumonia Firearms Hopelessness 7. Diabetes Sexual behavior Anger and frustration 8.. Suicide Motor vehicles Powerlessness and fear 8. Liver disease and cirrhosis Illicit use of drugs Economic despair 10. HIV/AIDS Meaningless existence Columns 1 & 2 -- Journal of the American Medical Association, McGinnis and Foege, 270:2207-2212, 11/93 Column 3 - Health Action

  21. Heart disease Cancer Cerebro-vascular disease Negative drug interactions Accidents Medical error COPD, Pneumonia & flu Diabetes Suicide Liver disease 10 Leading Causes of Death

  22. Tobacco Diet/activity patterns Alcohol Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs 9 Actual Causes of Death

  23. Lack of information Lack of lifestyle skills Lack of connection External & internal stress Economic despair Meaningless existence Low self-esteem Hopelessness Anger and frustration Powerlessness and fear Root Causes of Death

  24. In 1990 and 97, Eisenburg, 1 • 34%/56% of Americans used unconventional health care methods • 400/800 million visits to unconventional providers$13.7 billion was spent • 72%/35% of respondents did not inform their medical doctor New England Journal of Medicine, Eisenburg et al, 1/93 JAMA, Eisenburg, et al, 11/97

  25. In 1990 and 97, Eisenburg, 2Some of the therapies studied: • Relaxation & meditation practices • Weight-loss programs • Mega-vitamin and herbal supplements • Self-help and support groups • Therapeutic imagery & spiritual healing • Bio-feedback and hypnosis • Chiropractic • Acupuncture • Massage New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93

  26. In 1990 and 97, Eisenburg, 3The less frequently discussed points: • Only 10% of respondents used actual treatment provided by medical or licensed providers (Chiropractic, Acupuncture, Massage) • Most utilized unconventional methods were health improvement activities - Yoga, Tai Chi, meditation, support groups, etc New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93 and 97

  27. Archives of Internal MedicineStress & Heart DiseaseBlumenthal, et al, October, 1997Duke, National Heart Lung and Blood • Current annual stats, 13.5 million, $117billion • 107 patients - 3 groups - Standard tx, + exercise, + support • 33 in group support and stress management • 74% reduction in risk for second cardiac event • Standard tx - 30% second event • Standard tx plus exercise - 21% second event • Standard tx plus group support -9% second event

  28. Ornish Programfor Recovery from Heart Disease, Prostate Cancer, etc. • Nutrition • Exercise • Stress Mastery • Group Support • 88% avoided future procedures, no additional adverse event rates compared to controls = safe/effective. • Cost to franchise $30K to $100K+, cost per participant $3K to $15.

  29. How? • The Circle of Life program - Personal Health Assessment Self-Enhancement System (PHASES)

  30. The Circle of LifePersonal Health Assessment & Self-Energizing System The Circle of Life system has 7 phases: 1. Assess, self inquiry, data capture •Assessment Phase 2. Evaluate, discuss findings •Exploration Phase 3. Develop healthy living program •Personal Planning Phase 4. Individual implementation •Action Phase 5. Support and accountability •Support Phase 6. Re-evaluation, measure outcome •Re-evaluation Phase 7. Course correction •Re-design Phase

  31. Health educators Parish nurses Ministry professionals Social services Counselors, therapists Occupational therapists Physical therapists Human resources staff Health consultants Citizens, lay-persons Who provides coaching & Support Group facilitation

  32. Diet & nutrition Exercise & fitness Stress mastery Health care & self-care Relationships & family Work and career Financial health Humor, play & creativity Environment & nature Emotions & self-esteem Life purpose & service Spirituality & intuition Circle: Assesses & Supports Action in 12 Areas

  33. Rich opportunities are already in most hospitals: 1. Physical therapy department 2. Health education department 3. Comprehensive cancer 4. Cardiac rehabilitation 5. Diabetes services 6. Rehabilitation medicine

  34. Comprehensive Delivery The Public Consultation Consultation Self Inquiry Personal Plan Diagnosis Diagnosis Personal Action Treatment Treatment Group Support Conventional Medicine Health Promotion Complementary Medicine

  35. Monday Morning Begin to craft, from resources within the organization, programs and delivery pathways that maximize health improvement and complement already agreed upon clinical protocols. If necessary target this strategy in just one or two departments or at one or two diagnostic categories.

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