The Integration of Medical, Behavioral, and Complementary Services

1. The Integration of Medical, Behavioral, and Complementary Services The Primary Health Network Sharon, PA Diane Dado, LCSW Anita Booth, CRNP

2. The Center for Health and Well-Being Wellness NutritionChiropractic Acupuncture Gynecological Behavioral Health Complementary Medicine -Behavioral Health -Medical -Reiki -Massage -Exercise -Nutrition

3. Complementary Vs. Alternative Medicine Complementary Alternative refers to using a non-mainstream approach in place of conventional medicine. • refers to using a non-mainstream approach together with conventional medicine. Nutrition, massage, reiki, yoga, acupuncture, herbal, chiropractic services, hypnosis, meditation, Qigong

4. Integrative Medicine • “Healing-oriented medicine that re-emphasizes the relationship between the patient and the provider and integrates the best of complementary and alternative medicine with the best of conventional medicine.” (Institute of Medicine)

5. World Health Organization:Definition of Health • "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (1948 WHO Constitution)

6. Integrated Health Care

7. Integrated Health Care-It’s all connected

8. Evidenced- based medicine Exercise: Weight loss, Depression, Hypertension, Anxiety Reiki/Hypnotherapy: Stress, Chronic Pain, Anxiety, Smoking cessation Group/Socialization: Depression, improved health outcomes, increased motivation

9. Healthy People 2020 • A set of goals and objectives with 10 year targets designed to guide health promotion and disease prevention • Provides science based benchmarks to track and monitor progress • It is a tool for strategic management by the federal government, states, communities, and many other public and private-sector partners.

10. Healthy People 2020 Contains 26 leading health indicators with 12 main topics At CHWB we are offering 8 out of the 12 topics Access to health services Mental Health Nutrition Tobacco Substance Abuse (screening, education, and referral) Physical Activity, Obesity, DM Clinical preventative services-osteoporosis, cancer screening Reproductive & Sexual Health-adolescent health, family planning

11. Patient Centered Medical Home Taking Care of the Patient Dyslipidemia Acute/Chronic Pain Depression Osteoporosis smoking Fibromyalgia Anxiety Patient diabetes Hypertension obesity

12. Fibromyalgia/Pain • Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. • Tender points: Back of the head Between shoulder blades Top of shoulders Front sides of neck Upper chest Outer elbows Upper hips Sides of hips Inner knees

13. Fibromyalgia treatment • Medications-Analgesics, Antidepressants, anti-seizure • Therapy- individual and group mental health therapy • Lifestyle and Home remedies- stress reduction, physical activity, nutritional changes • Alternative medicine- acupuncture, yoga, massage therapy

14. Obesity As of June 2013, AMA has recognized obesity as a disease -Increases risks of: CV disease Hypertension DM type 2

15. Diabetes • Fasting plasma glucose >126mg/DL • 2HR glucose tolerance test >200mg/DL • HBA1C>6.5%

16. Who should be screened -Age 45 years of age with no risk factors -Overweight BMI >25 +1 of following risk factors • Physical inactivity • 1st degree relative DM • High risk race/ethnicity • Women delivering a baby >9lbs/ Gestational DM • HTN, HDL <35, TG>250 • PCO • HBA1C>5.7 previous testing • CVD

17. Glucose Intolerance Goals: • Target Loss 7% total body weight • Increase physical activity • 150min/wk moderate activity • Consider Metformin to prevent DM type 2 • BMI >35, less then 60 y.o., Gestational DM

18. JNC 7 guidelinesHypertension

19. JNC 7 guidelines Risk factors for cardiovascular disease Includes: Dyslipidemia DM Obesity Smoking Age Sex Smoking Renal dysfunction increased BP

20. Barriers to BP goals • Insufficient attention to health education by health care practitioners • Lack of reimbursement for health education • Lack of access to places for physical activity • Lack of exercise programs in schools • High cost of healthy foods/ High sodium in restaurant foods

21. Life style modifications

22. Patient Centered Medical HomeIt takes a TEAM PCP Chronic Pain Fibromyalgia smoking DM Patient HTN Depression obesity Behavioral Health Life style modifications team

23. Patient Centered Medical Home Life Style Modification Team Chronic Pain DM HTN smoking Patient Fibromyalgia obesity Chiropractic “GATEKEEPER” Acupuncture Behavioral Health Massage Hypno/Reiki Nutrition Exercise

24. Integrated Approach to Anxiety Sleep Problems Muscle tightness Isolation Patient Depression “Anxiety ” Therapy, RX Massage Hypno/Reiki Meditation group Exercise

25. Why this model? • Parallels PCMH features: • Enhanced access • Whole person care orientation • Coordinated and/or integrated care

26. Questions? • Diane Dado, LCSW The Primary Health Network Ddado@primary-health.net (724) 704-7413 • Anita Booth, CRNP The Primary Health Network Abooth@primary-health.net (724) 704-7413